Advisory Committee Candidate Biographical Information Request

Forms and Documents

Document Name	Status
Form DOT F 1120.1 Advisory Committee Candidate Biographical Information Request Form and Instruction	Modified
2105-0009_Supporting Statement - ICR - December 2018.doc Supporting Statement A	2018-12-11
2105-0009_30-Day_Notice_83.FR.44693_31.Aug.2018.pdf Supplementary Document	2018-08-31
60-day_Notice_for_2105-0009 -- Committee Candidate Biographical Info Request_Published_20180611_83FR27080.pdf Supplementary Document	2018-08-30
Privacy Act (P L 93-579).pdf Supplementary Document	2009-03-31
FACA - P L 92-463.pdf Supplementary Document	2009-03-31

IC Document Collections

IC ID	Document Title	Status
25072	Advisory Committee Candidate Biographical Information Request Form and Instruction	Modified

ICR Details

OMB Control No: 2105-0009	ICR Reference No: 201808-2105-004
Status: Active	Previous ICR Reference No: 200903-2105-002
Agency/Subagency: DOT/OST	Agency Tracking No: 2105-0009
Title: Advisory Committee Candidate Biographical Information Request
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/14/2019
	Date Received in OIRA: 12/11/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2022	36 Months From Approved
Responses	100	0	0
Time Burden (Hours)	25	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The collection is necessary to gather information from individuals interested in appointments to advisory committees and individuals who have been recommended for membership on an advisory committee to ensure that the committee is balanced and fairly and equitably represents, to the extent feasible, all the various interests that may be affected by the committee’s work and that undue weight not be afforded the views of any one interest, as required by the Federal Advisory Committee Act, P.L. 92-463. Responding to the collection is voluntary and is not required to obtain or retain a benefit. Respondents are members of the public who wish to serve on DOT committees. The collection is not for reporting or record-keeping. It is for disclosure of information to conduct a background check. The information is collected when they are first nominated and then upon re-appointment (if applicable). Disclosure of information is for conducting a background check. The information will be received by the Committee Management and contractor that will conduct the background check. The purpose of the collection is to vet any candidate that will serve on a DOT committee. This ICR is not a revision.

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Authorizing Statute(s): PL: Pub.L. 93 - 579 Section 2 Name of Law: The Privacy Act of 1974
   PL: Pub.L. 92 - 463 Section 10-12 Name of Law: Federal Advisory Committee Act
  

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:
	83 FR 27080	06/11/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 44693	08/31/2018
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
Advisory Committee Candidate Biographical Information Request	DOT F 1120.1	Advisory Committee Candidate Biographical Information Request

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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	100	0	0	0	0	100
Annual Time Burden (Hours)	25	0	0	0	0	25
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:

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Annual Cost to Federal Government: $0

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: 12/11/2018

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