Special Agent Medical (Preplacement/Incumbent)

Forms and Documents

Document Name	Status
Form ATF F 2300.10 Special Agent Medical (Preplacement/Incumbent) Form and Instruction	Modified
5 CFR 339.301 Authority to Require an Examination 1.1.2019.pdf Supplementary Document	2020-04-17
Justification for OMB 1140-0056 (ATF Form 2300.10) 4.23.2020.docx Supporting Statement A	2020-04-23

IC Document Collections

IC ID	Document Title	Status
12813	Special Agent Medical (Preplacement/Incumbent) Form and Instruction	Modified

ICR Details

OMB Control No: 1140-0056	ICR Reference No: 202004-1140-005
Status: Active	Previous ICR Reference No: 201702-1140-002
Agency/Subagency: DOJ/ATF	Agency Tracking No:
Title: Special Agent Medical (Preplacement/Incumbent)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/01/2020
	Date Received in OIRA: 04/23/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2023	36 Months From Approved	06/30/2020
Responses	288	0	120
Time Burden (Hours)	216	0	90
Cost Burden (Dollars)	3,600	0	1,440

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Abstract: The Special Agent Medical (Preplacement/Incumbent) Form - ATF Form 2300.10 is used to collect specific personally identifiable information (PII), including the name, address, telephone, social security number and certain medical data. The collected medical data is used to determine if a candidate is medically qualified for and can be hired to serve as a criminal investigator (special agent) or an explosives enforcement officer.

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Authorizing Statute(s): None

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:
	85 FR 7785	02/11/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 22444	04/22/2020
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
Special Agent Medical (Preplacement/Incumbent)	ATF F 2300.10	Special Agent Medical (Preplacement/Incumbent)

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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	288	120	0	168	0	0
Annual Time Burden (Hours)	216	90	0	126	0	0
Annual Cost Burden (Dollars)	3,600	1,440	0	2,160	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: The adjustments associated with this collection include an increase in the both the number of respondents and total burden hours associated with this IC from by 168 and 126 hours respectively. Due to more respondents and an increase in the postal rate, the public cost has also increased by $ 2,160, since the last renewal in 2017.

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Annual Cost to Federal Government: $300

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? No

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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: 04/23/2020

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