Application for Senior Administrative Law Judge & Geographic Preference Statement for Senior Administrative Law Judge

Forms and Documents

Document Name	Status
Form OPM 1655A Geographic Preference Statement for Senior Administrative Law Judge Applicant Form and Instruction	Modified
Form OPM 1655 Application for Senior Administrative Law Judge Form and Instruction	Modified
Federal Register Notice - Vol 83, No. 87 - 5-4-18.pdf Supplementary Document	2018-05-16
Federal Register Notice - Vol 82, No. 212 - 11-3-17.pdf Supplementary Document	2018-05-16
3206-0248 Supporting Statement.DOC Supporting Statement A	2018-05-16

IC Document Collections

IC ID	Document Title	Status
182393	Geographic Preference Statement for Senior Administrative Law Judge Applicant Form and Instruction	Modified
182362	Application for Senior Administrative Law Judge Form and Instruction	Modified

ICR Details

OMB Control No: 3206-0248	ICR Reference No: 201805-3206-004
Status: Active	Previous ICR Reference No: 201410-3206-002
Agency/Subagency: OPM	Agency Tracking No:
Title: Application for Senior Administrative Law Judge & Geographic Preference Statement for Senior Administrative Law Judge
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/25/2018
	Date Received in OIRA: 06/06/2018
Terms of Clearance: This collection is approved based on the revised materials provided by the Agency.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2021	36 Months From Approved	09/30/2018
Responses	350	0	350
Time Burden (Hours)	161	0	167
Cost Burden (Dollars)	0	0	0

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Abstract: OPM 1655 and OPM 1655A will be used by retired Administrative Law Judges seeking reemployment to complete hearings in accordance with the Administrative Procedures Act of 1946. These forms streamline the application process by providing all needed information on 2 forms. The forms have changed to only to include updated regional selections.

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Authorizing Statute(s): US Code: 5 USC 3323(b) Name of Law: null
  

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:
	79 FR 44872	08/01/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 64421	10/29/2014
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Geographic Preference Statement for Senior Administrative Law Judge Applicant	OPM 1655 A w/changes, OPM 1655A	OPM 1655 A w/changes ,   Geographic Peference Statement for Senior Adminstrative Law Judge Applicant
Application for Senior Administrative Law Judge	OPM 1655, OPM 1655 w/changes	Application for Senior Administrative Law Judge ,   OPM 1655 w/changes

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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	350	350	0	0	0	0
Annual Time Burden (Hours)	161	167	0	-6	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: There is an increase of usage of both forms as well as both forms receiving changes to clarify instructions and streamline the completion.

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Annual Cost to Federal Government: $7,607

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

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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: 06/06/2018

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