Continuation Sheet for Item # 15 (Additional Information) OF-306, Declaration for Federal Employment

Forms and Documents

Document	Type	Status	Availability
Form 12114 Form 12114 - Continuation Sheet for Item # 15 (Additional Information) OF-306, Declaration for Federal Employment	Form	Modified	Available
2017-11-30 SS 1545-1921r.doc	Supporting Statement A	Uploaded 2017-12-07	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
19623	Form 12114 - Continuation Sheet for Item # 15 (Additional Information) OF-306, Declaration for Federal Employment	Form	Modified

ICR Details

OMB Control No: 1545-1921	ICR Reference No: 201711-1545-003
Status: Active	Previous ICR Reference No: 201409-1545-038
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: Continuation Sheet for Item # 15 (Additional Information) OF-306, Declaration for Federal Employment
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: 03/19/2018
	Date Received in OIRA: 01/12/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2021	36 Months From Approved	03/31/2018
Responses	24,813	0	24,813
Time Burden (Hours)	6,203	0	6,203
Cost Burden (Dollars)	0	0	0

---

Abstract: Form 12114 is used by recruitment personnel of the Covington Host Site. This form is provided to applicants when completing OF 306, Declaration for Federal Employment. It is used as a continuation sheet to clearly define additional information that is requested in item 15 of the OF 306. Due to lack of space on the OF 306 this form can be used in lieu of an additional sheet of paper. The authority to request this information is in 5 USC 3301 and 3304.

---

Authorizing Statute(s): US Code: 5 USC 3301 Name of Law: Civil Service; Generally
   US Code: 5 USC 3304 Name of Law: Competative Service; Examinations
  

Citations for New Statutory Requirements: None

---

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 49266	10/24/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 1659	01/12/2018
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Form 12114 - Continuation Sheet for Item # 15 (Additional Information) OF-306, Declaration for Federal Employment	12114	Continuation Sheet (Additional Information) for OF-306, Declaration for Federal Employment

---

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	24,813	24,813	0	0	0	0
Annual Time Burden (Hours)	6,203	6,203	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $2,950

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:  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:

(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: 01/12/2018

---