Donor Certification Form

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DI-3680 State, Local or Tribal Government	Form	Modified	Available
Form DI-3680 Businesses and Organizations	Form	Modified	Available
Form DI-3680 Individuals and Households	Form	Modified	Available
54 U.S.C. § 101101.pdf	Supplementary Document	Uploaded 2018-10-23	Available
54 U.S.C. 200103(i).pdf	Supplementary Document	Uploaded 2018-10-23	Available
54 U.S.C. § 307107.pdf	Supplementary Document	Uploaded 2018-10-23	Available
54 U.S.C. § 102503(b).pdf	Supplementary Document	Uploaded 2018-10-23	Available
54 U.S.C. § 101111.pdf	Supplementary Document	Uploaded 2018-10-23	Available
43 U.S.C. § 1473.pdf	Supplementary Document	Uploaded 2018-10-23	Available
25 U.S.C. § 2006(f)(1).pdf	Supplementary Document	Uploaded 2018-10-23	Available
16 U.S.C. § 3192(i).pdf	Supplementary Document	Uploaded 2018-10-23	Available
2018 DI-3680 Supporting Statment 10-22-18.docx	Supporting Statement A	Uploaded 2018-10-23	Available
1090-0009 30 Day Notice - 83 FR 53291.pdf	Supplementary Document	Uploaded 2018-10-22	Available
1090-0009 - 60 Day Notice FRN.pdf	Supplementary Document	Uploaded 2018-09-17	Available
USCODE-2013-title25 458ddd.pdf	Supplementary Document	Uploaded 2015-09-08	Available
USCODE-2013-title16 3196.pdf	Supplementary Document	Uploaded 2015-09-08	Available
USCODE-2013-title16 3192.pdf	Supplementary Document	Uploaded 2015-09-08	Available
USCODE-2013-title30-chap25 1231.pdf	Supplementary Document	Uploaded 2015-09-08	Available
USCODE-2013-title43 1473.pdf	Supplementary Document	Uploaded 2015-09-08	Available
USCODE-2013-title43 36a-c.pdf	Supplementary Document	Uploaded 2015-09-08	Available
USCODE-2013-title16 3701.pdf	Supplementary Document	Uploaded 2015-09-08	Available
USCODE-2013-title16 3741.pdf	Supplementary Document	Uploaded 2015-09-08	Available
USCODE-2013-title16 661.pdf	Supplementary Document	Uploaded 2015-09-08	Available
USCODE-2013-title43 395.pdf	Supplementary Document	Uploaded 2015-09-08	Available
USCODE-2013-title43 1701.pdf	Supplementary Document	Uploaded 2015-09-08	Available
USCODE-2013-title25 500c.pdf	Supplementary Document	Uploaded 2015-09-08	Available
USCODE-2013-title16 4601-4608.pdf	Supplementary Document	Uploaded 2015-09-08	Available
374 DM 6.htm	Supplementary Document	Uploaded 2009-03-12	Available
18 USC 201.pdf	Supplementary Document	Uploaded 2009-01-27	Available
9 Stat. at L. 395-7.pdf	Supplementary Document	Uploaded 2009-01-27	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
187613	State, Local or Tribal Government	Form	Modified
187612	Businesses and Organizations	Form	Modified
187609	Individuals and Households	Form	Modified

ICR Details

OMB Control No: 1090-0009	ICR Reference No: 201809-1090-001
Status: Active	Previous ICR Reference No: 201509-1090-001
Agency/Subagency: DOI/ASPMB	Agency Tracking No:
Title: Donor Certification Form
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: 12/14/2018
	Date Received in OIRA: 10/23/2018
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is approved for three years.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2021	36 Months From Approved	12/31/2018
Responses	115	0	250
Time Burden (Hours)	39	0	84
Cost Burden (Dollars)	0	0	0

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Abstract: The Department of the Interior and its bureaus (Department or DOI) has various authorities that permit the acceptance of donations or gifts in furtherance of resource conservation projects and other programs. Before accepting a donation, DOI must first evaluate whether or not the circumstances of the donation maintain the integrity of the Department's programs and operations, the impartiality of the Department, and public confidence in the Department. Prior to enacting the Donations Policy, DOI conducted a risk analysis in which $25,000 was determined to be the threshold above which there was a greater risk of possible legal or ethical questions associated with donations. Therefore, for donations valued at $25,000 or more, donors are requested to complete a DI-3680 Donor Certification form (DI-3680 form) to provide information clarifying business and legal interactions with the Department and consistency with the Donations Policy prior to acceptance.

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Authorizing Statute(s): Statute at Large: 9 Stat. 395 Name of Statute: An Act to Establish the Home Department
   US Code: 18 USC 201 Name of Law: Bribery, Graft, and Conflicts of Interest
   US Code: 16 USC 460/-1h Name of Law: Outdoor Recreation Authority - Donations
   US Code: 16 USC 4601-4608 Name of Law: Take Pride in America Program
   US Code: 25 USC 5341 Name of Law: Donations for Indians; use of gifts
   US Code: 25 USC 2006 Name of Law: BIE Accepting Gifts
   US Code: 43 USC 1701 and 1737c Name of Law: Federal Land Policy and Management Act of 1976 (FLPMA)
   US Code: 43 USC 395 Name of Law: BOT - Acceptance of Non-Federal Funds
   US Code: 16 USC 661 Name of Law: Partnerships for Fish and Wildlife
   US Code: 16 USC 3741 Name of Law: Partnerships for Wildlife Program
   US Code: 16 USC 3701 Name of Law: Cooperation with the National Fish and Wildlife Foundation
   US Code: 43 USC 36a-c Name of Law: USGS - Gift and General Cooperation Authority
   US Code: 43 USC 1473 Name of Law: BOEM - Gift Authority
   US Code: 54 USC 101101 Name of Law: General Authority for NPS to Accept Donations
   US Code: 54 USC 102503(b) Name of Law: Donations for Museum Purposes
   US Code: 54 USC 101111 Name of Law: Donations to the National Park Foundation (NPF) for the Benefit of NPS
   US Code: 54 USC 307107 Name of Law: Donations and Bequests of Money, Personal Property and Less than Fee Interests in Historic Property
   US Code: 30 USC 1231b3 Name of Law: Abandoned Mine Reclamation Fund
   US Code: 16 USC 3192 Name of Law: ANILCA - Land acquisition authority
   US Code: 16 USC 3196 Name of Law: ANILCA - Administrative sites and visitor facilities
   US Code: 54 USC 200103(i) Name of Law: Authority of the Secretary to Carry out Certain Functions and Activities
  

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 20852	05/08/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 53291	10/22/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
State, Local or Tribal Government	DI-3680	Donor Certification Form
Individuals and Households	DI-3680	Donor Certification Form
Businesses and Organizations	DI-3680	Donor Certification Form

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ICR Summary of Burden

table that charts list 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	115	250	0	0	-135	0
Annual Time Burden (Hours)	39	84	0	0	-45	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:

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Annual Cost to Federal Government: $18,495

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: 10/23/2018

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