Interview Survey Form (INV 10)

Forms and Documents

Document Name	Status
Form INV 10 Interview Survey Form Form and Instruction	Modified
Part B _ INV 10_6.2019_ROCIS.docx Supporting Statement B	2019-06-27
INV 10, 30 Day FRN, Vol. 84, No. 122, Tuesday, June 25, 2019, Page 29885.pdf Supplementary Document	2019-06-26
INV 10, Supporting Statement 5-2019 DMS FINAL.doc Supporting Statement A	2019-05-29
INV 10, 60 Day Federal Register, Vol. 84, No. 22, Friday, February 1 2019, Page 1250.msg Supplementary Document	2019-05-29

IC Document Collections

IC ID	Document Title	Status
33582	Interview Survey Form Form and Instruction	Modified

ICR Details

OMB Control No: 0705-0004	ICR Reference No: 201909-0705-004
Status: Active	Previous ICR Reference No: 201506-3206-001
Agency/Subagency: DOD/OUSDI	Agency Tracking No:
Title: Interview Survey Form (INV 10)
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: 09/30/2019
	Date Received in OIRA: 09/30/2019
Terms of Clearance: This collection is approved based on the additional materials provided by the Agency.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2022	36 Months From Approved
Responses	67,391	0	61,973
Time Burden (Hours)	6,739	0	6,197
Cost Burden (Dollars)	119,031	0	0

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Abstract: The Interview Survey Form, INV 10, is mailed by OPM, to a random sampling of record and personal sources contacted during background investigations when investigators have performed fieldwork. The INV 10 is used as a quality control instrument designed to ensure the accuracy and integrity of the investigative product. The form queries the recipient about the investigative procedure exhibited by investigator, the investigator's professionalism, and the information discussed and reported.

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Authorizing Statute(s): EO: EO 10450 Name/Subject of EO: null
   EO: EO 12968 Name/Subject of EO: 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:
	84 FR 1250	02/01/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 122	06/25/2019
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
Interview Survey Form	INV 10, INV 10	Interview Survey Form ,   Interview Survey Form

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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	67,391	61,973	0	5,418	0	0
Annual Time Burden (Hours)	6,739	6,197	0	542	0	0
Annual Cost Burden (Dollars)	119,031	0	0	119,031	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Burden increase is due to the increased number of INV 10 mailed in response to the increased number of background investigations being conducted.

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Annual Cost to Federal Government: $119,031

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: 06/27/2019

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