0704-scot_ss-a_5.29.2020

SUPPORTING STATEMENT - PART A

Scooter Registration Form – 0704-XXXX

Summary of Changes from Previously Approved Collection

The collection is new.

1. Need for the Information Collection

Washington Headquarters Services (WHS) needs to collect this information to be able to provide reasonable accommodations to WHS and WHS-serviced organizations’ personnel needing mobility assistance for individuals with disabilities.

• DoD Directive 1020.02; Diversity Management and Equal Opportunity (EO) in DoD

• Americans with Disabilities Act of 1990, 42 U.S.C. Ch. 126 § 12101 et seq.

2. Use of the Information

A Pentagon-wide building-circular will be sent to inform all WHS and WHS-serviced organization employees of the registration process/Requirements. All individuals in need of Personal Mobility Devices (PMD), aka Scooters, will be required to register their vehicles.

Information will be collected from the Agencies that desire to provide PMDs for their personnel with mobility-related issues. The individual users of the PMD will be asked to complete the subject form by providing their identifying information (name, email address phone number etc.), along with their work location. In addition, they will provide the Make, Model and Serial number of the PMD they wish to register. The individuals will need a letter from their Agency or Company’s Reasonable Accommodations Representative (RAR), verifying their need to use the PMD. Their Supervisor will verify their information. The Occupational Safety and Health Branch (OSHB) will collect and deposit the information collected during the process. Successful collection will result in an organized process for management of PMDs (Scooters) at the Pentagon Reservation.

3. Use of Information Technology

All (100%) potential users will be sent out this information via email, and they will be expected to return the completed document electronically, as well.

4. Non-duplication

The information obtained through this collection is unique and is not already available for use or adaptation from another cleared source.

5. Burden on Small Businesses

This information collection does not impose a significant economic impact on a substantial number of small businesses or entities.

6. Less Frequent Collection

This information will be collected once per the individual user, for the registration of the PMD. Once the individual leaves the Pentagon Reservation, that registration will be discontinued and the PMD will be taken away. If the PMD is needed for another user, it will need to be registered again.

7. Paperwork Reduction Act Guidelines

This collection of information does not require collection to be conducted in a manner inconsistent with the guidelines delineated in 5 CFR 1320.5(d)(2).

8. Consultation and Public Comments

Part A: PUBLIC NOTICE

A 60-Day Federal Register Notice (FRN) for the collection published on Thursday, January 16, 2020. The 60-Day FRN citation is 85 FRN 2728

No comments were received during the 60-Day Comment Period.

A 30-Day Federal Register Notice for the collection published on Friday, May 29, 2020. The 30-Day FRN citation is 85 FRN 32367.

Part B: CONSULTATION

No additional consultation apart from soliciting public comments through the Federal Register was conducted for this submission.

9. Gifts or Payment

No payments or gifts are being offered to respondents as an incentive to participate in the collection.

10. Confidentiality

A Privacy Act Statement is not required for this collection because we are not requesting individuals to furnish personal information for a system of records.

A System of Record Notice (SORN) is not required for this collection because records are not retrievable by PII.

A Privacy Impact Assessment (PIA) is not required for this collection because PII is not being collected electronically.

Retention and Disposal: Data is destroyed/deleted 3 years after users request for account is terminated or inactive; or when information posted is superseded.

11. Sensitive Questions

No questions considered sensitive are being asked in this collection.

12. Respondent Burden and its Labor Costs

Part A: ESTIMATION OF RESPONDENT BURDEN

1. SD-836 Scooter Registration Form

1. Number of Respondents: 100

2. Number of Responses Per Respondent: 1

3. Number of Total Annual Responses: 100

4. Response Time: 2 hours

5. Respondent Burden Hours: 200

2. Total Submission Burden

   1. Total Number of Respondents: 100

   2. Total Number of Annual Responses: 100

   3. Total Respondent Burden Hours: 200 hours

Part B: LABOR COST OF RESPONDENT BURDEN

1. SD-836 Scooter Registration Form

1. Number of Total Annual Responses: 100

2. Response Time: 2 hours

3. Respondent Hourly Wage: $31.33*

4. Labor Burden per Response: $62.66

5. Total Labor Burden: $6,266

2. Overall Labor Burden

   1. Total Number of Annual Responses: 100

   2. Total Labor Burden: Initial $6,266

*Estimated average wage using the Washington DC area GS-9, Step 5 hourly rate.

13. Respondent Costs Other Than Burden Hour Costs

There are no annualized costs to respondents other than the labor burden costs addressed in Section 12 of this document to complete this collection.

14. Cost to the Federal Government

Part A: LABOR COST TO THE FEDERAL GOVERNMENT

1. SD-836 Scooter Registration Form

1. Number of Total Annual Responses: 100

2. Processing Time per Response: 5 minutes

3. Hourly Wage of Worker(s) Processing Responses : $31.33

4. Cost to Process Each Response: $2.61

5. Total Cost to Process Responses: $261

2. Overall Labor Burden to the Federal Government

   1. Total Number of Annual Responses: 100

   2. Total Labor Burden: $261.00

Part B: OPERATIONAL AND MAINTENANCE COSTS

1. Cost Categories

   1. Equipment: $0

   2. Printing: $0

   3. Postage: $0

   4. Software Purchases: $0

   5. Licensing Costs: $0

   6. Other: $0

2. Total Operational and Maintenance Cost: $0

Part C: TOTAL COST TO THE FEDERAL GOVERNMENT

1. Total Labor Cost to the Federal Government: $261

2. Total Operational and Maintenance Costs: $0

3. Total Cost to the Federal Government: $261.00

15. Reasons for Change in Burden

This is a new collection with a new associated burden.

16. Publication of Results

The results of this information collection will not be published.

17. Non-Display of OMB Expiration Date

We are not seeking approval to omit the display of the expiration date of the OMB approval on the collection instrument.

18. Exceptions to “Certification for Paperwork Reduction Submissions”

We are not requesting any exemptions to the provisions stated in 5 CFR 1320.9.

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