Government, Corporate or Foundation, and Individual Donor Form Application

Forms and Documents

Document Name	Status
Form DS-4271 Government, Corporate or Foundation, and Individual Donor Form Applications Form and Instruction	Modified
Legal Authorities Gifts.docx Supplementary Document	2017-10-18
Final - Supporting Statement.docx Supporting Statement A	2017-10-18

IC Document Collections

IC ID	Document Title	Status
214454	Government, Corporate or Foundation, and Individual Donor Form Applications Form and Instruction	Modified

ICR Details

OMB Control No: 1405-0218	ICR Reference No: 201710-1405-002
Status: Active	Previous ICR Reference No: 201412-1405-002
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Government, Corporate or Foundation, and Individual Donor Form Application
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/05/2017
	Date Received in OIRA: 10/18/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2020	36 Months From Approved	12/31/2017
Responses	4,333	0	3,665
Time Burden (Hours)	361	0	305
Cost Burden (Dollars)	2,123	0	1,833

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Abstract: The Office of Emergencies in the Diplomatic and Consular Services (EDCS) manages the solicitation and acceptance of gifts to the U.S. Department of State. The information requested via donor forms is a necessary first step in accepting donations. The information sought is pursuant to 22 U.S.C 2697, 5 U.S.C. 7342 and 22 CFR, Part 3.

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Authorizing Statute(s): US Code: 5 USC 7342 Name of Law: Foreign Gifts and Decorations Act
   US Code: 22 USC 2697 Name of Law: State Department Basic Authorities Act of 1956
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 31386	07/06/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 48307	10/17/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Government, Corporate or Foundation, and Individual Donor Form Applications	DS-4271, DS-4272, DS-4273	Donor Form - Government ,   Donor Form - Corporate or Foundation ,   Donor Form - Individual

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	4,333	3,665	0	668	0	0
Annual Time Burden (Hours)	361	305	0	56	0	0
Annual Cost Burden (Dollars)	2,123	1,833	0	290	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There was a slight increase in the burden hours associated with this collection, from 305 hours to 361, due to an increase of 56 donations since the last time this collection was approved

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Annual Cost to Federal Government: $30,482

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/18/2017

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