Freedom of Information/Privacy Act Record Request Form

Forms and Documents

Document	Type	Status	Availability
Form 507-1 Certification of Identity Form	Form and Instruction	New	Available
2018 FOIA Supporting Statement with changes.docx	Supporting Statement A	Uploaded 2018-04-13	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
228906	Certification of Identity Form	Form and Instruction	New
212451	Freedom of Information/Privacy Act Records Request	Other-Privacy Statement	Modified

ICR Details

OMB Control No: 0412-0589	ICR Reference No: 201711-0412-002
Status: Active	Previous ICR Reference No: 201312-0412-001
Agency/Subagency: AID	Agency Tracking No:
Title: Freedom of Information/Privacy Act Record Request Form
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  Yes
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 04/27/2018
	Date Received in OIRA: 11/02/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2021	36 Months From Approved	04/30/2018
Responses	600	0	600
Time Burden (Hours)	300	0	90
Cost Burden (Dollars)	0	0	0

---

Abstract: Information is needed to locate and provide applicable records to requests made under the freedom of Information Act and the Privacy Act of 1974. Information includes sufficient identifiable information and/or source documents as applicable. Respondents can include any personal/individual with the exception of a fugitive.

---

Authorizing Statute(s): US Code: 5 USC 552.5. 522.a Name of Law: Freedom of Information and the Privacy Act of 1974
  

Citations for New Statutory Requirements: US Code: 5 USC 552.5 Name of Law: Freedom of Information Act/Privacy Act of 1974

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 39556	08/21/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 50371	10/31/2017
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Certification of Identity Form	507-1	Certification of Identity
Freedom of Information/Privacy Act Records Request	AID 507-1	Freedom of Information/Privacy Act Record Request Form

---

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	600	600	0	0	0	0
Annual Time Burden (Hours)	300	90	0	210	0	0
Annual Cost Burden (Dollars)	0	0	0	0	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: Remove the SSN from the updated form

---

Annual Cost to Federal Government: $1,800,000

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.     Yes

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

---

Common Form ICR:  Yes

Description/Changes for Common Form Usage:  Remove the SSN from the updated form

Approved RCFs using this ICR

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title

---

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: 11/02/2017

---