RECORDS AND ADMINISTRATION

ICR 201710-1910-002

OMB: 1910-1700

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2017-10-31
Supplementary Document
2017-10-31
Supporting Statement A
2018-01-30
IC Document Collections
IC ID
Document
Title
Status
137543 Modified
ICR Details
1910-1700 201710-1910-002
Active 201403-1910-002
DOE/DOEOA Brooke Dickson-Knowles
RECORDS AND ADMINISTRATION
Revision of a currently approved collection   No
Regular
Approved with change 01/30/2018
Retrieve Notice of Action (NOA) 10/31/2017
  Inventory as of this Action Requested Previously Approved
01/31/2021 36 Months From Approved 01/31/2018
135 0 135
45 0 45
0 0 0

The Privacy Act Information Request Form assists the Department of Energy in processing privacy requests submitted by an individual or an authorized designee where-in he or she is requesting records the government may maintain on them. This form will increase efficiencies including, but not limited to quicker processing of privacy requests by asking individuals or their designees pertinent information for easy record retrieval.

US Code: 5 USC 552a Name of Law: Records Maintained on Individuals
  
None

Not associated with rulemaking

  82 FR 67 04/10/2017
82 FR 179 09/18/2017
No

1
IC Title Form No. Form Name
PRIVACY ACT ADMINISTRATION DOE F 531 PRIVACY ACT INFORMATION REQUEST

  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 135 135 0 0 0 0
Annual Time Burden (Hours) 45 45 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$7,584
No
    Yes
    Yes
No
No
No
Uncollected
Christina Rouleau 301 903-6227 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
10/31/2017


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