Office of the Secretary of Defense (OSD) Confidential Conflict-of-Interest Statement for Advisory Committee Members

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SD0830 Office of the Secretary of Defense (OSD) Confidential Conflict-of-Interest Statement for Advisory Committee Members	Form	Modified	Available
SSA 0704-0551 2019.DOC	Supporting Statement A	Uploaded 2019-02-13	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
219594	Office of the Secretary of Defense (OSD) Confidential Conflict-of-Interest Statement for Advisory Committee Members	Form	Modified

ICR Details

OMB Control No: 0704-0551	ICR Reference No: 201901-0704-002
Status: Active	Previous ICR Reference No: 201601-0704-001
Agency/Subagency: DOD/DODDEP	Agency Tracking No: 0704-AAIU
Title: Office of the Secretary of Defense (OSD) Confidential Conflict-of-Interest Statement for Advisory Committee Members
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: 03/18/2019
	Date Received in OIRA: 02/13/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2022	36 Months From Approved	03/31/2019
Responses	125	0	125
Time Burden (Hours)	125	0	125
Cost Burden (Dollars)	906	0	906

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Abstract: The information request on this form is required by Title I of the Ethics in Government Act of 1978 (U.S.C. App.), Executive Order 12674, and 5 C.F.R. part 2634, subpart I, of the Office of Government Ethics regulations. The requested information is necessary to prevent conflicts of interest and to identify potential conflicts of individuals serving on certain OSD Advisory Committees.

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Authorizing Statute(s): US Code: 5 USC app., sec. 107(a) Name of Law: The Ethics in Government Act of 1978
   EO: EO 12674 Name/Subject of EO: Principles of Ethical Conduct for Government Officers and Employees
  

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 56830	11/14/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 3423	02/12/2019
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Office of the Secretary of Defense (OSD) Confidential Conflict-of-Interest Statement for Advisory Committee Members	SD0830	OFFICE OF THE SECRETARY OF DEFENSE (OSD) CONFIDENTIAL CONFLICT-OF-INTEREST STATEMENT FOR OSD ADVISORY COMMITTEE MEMBERS

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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	125	125	0	0	0	0
Annual Time Burden (Hours)	125	125	0	0	0	0
Annual Cost Burden (Dollars)	906	906	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: $4,854

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: 02/13/2019

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