IHS Background Investigations of Individuals in Positions Involving Regular Contact with or Control Over Indian Children

Forms and Documents

Document Name	Status
Form 0917-0028 IHS Background Investigation of Individuals in Positions Involving Regular Contact with or Control Over Indian Children Form and Instruction	Modified
0917-0028_Supporting_Statement_B__2018.doc Supporting Statement B	2018-11-28
Final_AddendumtoDeclarationorFederalEmploymentOGCPHD final copy 9.20.18.doc Supplementary Document	2018-11-28
0917-0028_Supporting_Statement_A__2018.doc Supporting Statement A	2018-11-28
Title_42_chap_132_13041._Requirement_for_background_checks[1].doc Supplementary Document	2012-06-11
USCODE-2011-title25-chap34-sec3207.pdf Supplementary Document	2012-06-11
OMB Form No. 3206-0182 0306[1].pdf Supplementary Document	2012-06-11

IC Document Collections

IC ID	Document Title	Status
6586	IHS Background Investigation of Individuals in Positions Involving Regular Contact with or Control Over Indian Children Form and Instruction	Modified

ICR Details

OMB Control No: 0917-0028	ICR Reference No: 201811-0917-002
Status: Active	Previous ICR Reference No: 201509-0917-001
Agency/Subagency: HHS/IHS	Agency Tracking No: 0917-0028
Title: IHS Background Investigations of Individuals in Positions Involving Regular Contact with or Control Over Indian Children
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: 02/04/2019
	Date Received in OIRA: 11/28/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2022	36 Months From Approved	02/28/2019
Responses	3,000	0	3,000
Time Burden (Hours)	600	0	600
Cost Burden (Dollars)	0	0	0

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Abstract: To collect information needed to determine whether a prospective or current employee that has regular contact with or control over Indian children meets the minimum standards or character and to conduct background investigation.

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Authorizing Statute(s): PL: Pub.L. 101 - 630 408 Name of Law: Indian Child Protection and Family Violence Prevention Act
   PL: Pub.L. 106 - 568 814 Name of Law: Technical Amendment to the Indian Child Protection and Family Violence Protection Act
   US Code: 42 USC 13041 Name of Law: Public Health and Welfare Act, Requirement for Background Checks
   US Code: 25 USC 3201-3211 Name of Law: Indian Child Protection and Family Violence Prevention
  

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 48831	09/27/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 60877	11/27/2018
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
IHS Background Investigation of Individuals in Positions Involving Regular Contact with or Control Over Indian Children	0917-0028	Final Addendum to Declaration of Federal Employment

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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	3,000	3,000	0	0	0	0
Annual Time Burden (Hours)	600	600	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:

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Annual Cost to Federal Government: $1,800

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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: 11/28/2018

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