Federal Fish and Wildlife Permit Applications and Reports - Native Endangered and Threatened Species; 50 CFR 10, 13, and 17

Forms and Documents

Document	Type	Status	Availability
Form 3-200-54 SHA/CCAA (Application Form 3-200-54) - Individuals	Form and Instruction	Unchanged	Available
Form 3-200-60 Interstate Commerce Permit Application (Form 3-200-59) - Government	Form and Instruction	New	Repair queued
Form 3-200-60 (ePermits) Interstate Commerce Permit Application (Form 3-200-60) - Private Sector	Form and Instruction	New	Repair queued
Form 3-200-60 (ePermits) Interstate Commerce Permit Application (Form 3-200-60) - Individuals	Form and Instruction	New	Available
Form 3-200-60 Interstate Commerce Permit Application (Form 3-200-59) - Government	Form and Instruction	New	Repair queued
Form 3-200-60 Interstate Commerce Permit Application (Form 3-200-60) - Private Sector	Form and Instruction	New	Available
Form 3-200-60 Interstate Commerce Permit Application (Form 3-200-60) - Individuals	Form and Instruction	New	Repair queued
Form 3-200-59 (ePermits) Recovery Permit Application (Form 3-200-59) - Government	Form and Instruction	New	Repair queued
Form 3-200-59 (ePermits) Recovery Permit Application (Form 3-200-59) - Private Sector	Form and Instruction	New	Available
Form 3-200-59 (ePermits) Recovery Permit Application (Form 3-200-59) - Individuals	Form and Instruction	New	Available
Form 3-200-59 Recovery Permit Application (Form 3-200-59) - Government	Form and Instruction	New	Available
Form 3-200-59 Recovery Permit Application (Form 3-200-59) - Private Sector	Form and Instruction	New	Repair queued
Form 3-200-59 Recovery Permit Application (Form 3-200-59) - Individuals	Form and Instruction	New	Repair queued
Form 3-202-55g Quarterly Report (Form 3-202-55g Turtle Rehabilitation) - Private Sector	Form and Instruction	Unchanged	Repair queued
Form 3-202-55f Annual Report (Form 3-202-55f Non-Releasable Sea Turtles) - Government	Form and Instruction	Unchanged	Repair queued
Form 3-202-55f Annual Report (Form 3-202-55f Non-Releasable Sea Turtles) - Private Sector	Form and Instruction	Unchanged	Available
Form 3-202-55e Annual Report (Form 3-202-55e Region 6 Bat Reporting) - Government	Form and Instruction	Unchanged	Available
Form 3-202-55e Annual Report (Form 3-202-55e Region 6 Bat Reporting) - Private Sector	Form and Instruction	Unchanged	Available
Form 3-202-55e Annual Report (Form 3-202-55e Region 6 Bat Reporting) - Individuals	Form and Instruction	Unchanged	Repair queued
Form 3-202-55d Annual Report (Form 3-202-55d Region 5 Bat Reporting) - Government	Form and Instruction	Unchanged	Available
Form 3202-55d Annual Report (Form 3-202-55d Region 5 Bat Reporting) - Private Sector	Form and Instruction	Unchanged	Available
Form 3-202-55d Annual Report (Form 3-202-55d Region 5 Bat Reporting) - Individuals	Form and Instruction	Unchanged	Repair queued
Form 3-202-55c Annual Report (Form 3-202-55c Region 4 Bat Reporting) - Government	Form and Instruction	Unchanged	Repair queued
Form 3-202-55c Annual Report (Form 3-202-55c Region 4 Bat Reporting) - Private Sector	Form and Instruction	Unchanged	Repair queued
Form 3-202-55c Annual Report (Form 3-202-55c Region 4 Bat Reporting) - Individuals	Form and Instruction	Unchanged	Repair queued
Form 3-202-55b Annual Report (Form 3-202-55b Region 3 Bat Reporting) - Government	Form and Instruction	Unchanged	Repair queued
Form 3-202-55b Annual Report (Form 3-202-55b Region 3 Bat Reporting) - Private Sector	Form and Instruction	Unchanged	Available
Form 3-202-55b Annual Report (Form 3-202-55b Region 3 Bat Reporting) - Individuals	Form and Instruction	Unchanged	Repair queued
Form 3-200-56 Habitat Conservation Plan (Application Form 300-200-56) - Government	Form and Instruction	Unchanged	Available
Form 3-200-56 Habitat Conservation Plan (Application Form 300-200-56) - Private Sector	Form and Instruction	Unchanged	Repair queued
Form 3-200-56 Habitat Conservation Plan (Application Form 300-200-56) - Individuals	Form and Instruction	Unchanged	Repair queued
Form 3-200-55 Recovery/Interstate Commerce (Application Form 3-200-55) - Government	Form and Instruction	Removed	Available
Form 3-200-55 Recovery/Interstate Commerce (Application Form 3-200-55) - Private Sector	Form and Instruction	Removed	Repair queued
Form 3-200-55 Recovery/Interstate Commerce (Application Form 3-200-55) - Individuals	Form and Instruction	Removed	Repair queued
Form 3-200-54 SHA/CCAA (Application Form 3-200-54) - Government	Form and Instruction	Unchanged	Available
Form 3-200-54 SHA/CCAA (Application Form 3-200-54) - Private Sector	Form and Instruction	Unchanged	Repair queued
1018-0094 Justification for de minimus nonsubstantive change 05212020.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2020-05-22	Repair queued
Combined HCP Instruction Files ver 08292018.pdf	Supplementary Document	Uploaded 2019-03-25	Repair queued
How to Apply for ES Permits 03192019.pdf	Supplementary Document	Uploaded 2019-03-25	Available
HCP Incidental Take Dec 2005.pdf	Supplementary Document	Uploaded 2019-03-25	Available
HCP FAQs ver 08292018.pdf	Supplementary Document	Uploaded 2019-03-25	Repair queued
50 CFR Part 10.pdf	Supplementary Document	Uploaded 2018-01-12	Available
Permits SORN FWS-21 73 FR 31877.pdf	Supplementary Document	Uploaded 2019-03-25	Repair queued
FWS Process and Conditions for Telemetry Attachments Sea Turtles Final.pdf	Supplementary Document	Uploaded 2017-10-31	Available
FWS Sea Turtle Permit FAQs and Standard Permit Conditions.pdf	Supplementary Document	Uploaded 2017-10-31	Available
1018-0094 Habitat Conservation Planning and Incidental Take Permit Processing Handbook.pdf	Supplementary Document	Uploaded 2017-10-31	Available
SPITS PIA Information Collection 1018-0094 ESsigned.pdf	Supplementary Document	Uploaded 2017-11-16	Available
Instructions 2017 Electronic Submittal Bat Survey Data.pdf	Supplementary Document	Uploaded 2017-08-15	Available
FAQ Bat Electronic Reporting Spreadsheet 07132016.pdf	Supplementary Document	Uploaded 2017-08-15	Repair queued
2017 INBA Summer Survey Guidelines 05092017.pdf	Supplementary Document	Uploaded 2017-08-15	Available
1018-0094 30-day FRN Published 01312017 82019 8840 2017-02110.pdf	Supplementary Document	Uploaded 2017-01-31	Available
1018-0094 SSA Response to OMB's Terms of Clearance 03252019.docx	Supporting Statement A	Uploaded 2019-03-25	Repair queued
FRN60Day.1018.0094.pdf	Supplementary Document	Uploaded 2016-12-19	Available
ESA.pdf	Supplementary Document	Uploaded 2010-10-05	Available
50 CFR 17.pdf	Supplementary Document	Uploaded 2010-10-05	Available
50 CFR 13.pdf	Supplementary Document	Uploaded 2010-10-05	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
38235	SHA/CCAA (Application Form 3-200-54) - Individuals	Form and Instruction	Unchanged
241962	Interstate Commerce Permit Application (Form 3-200-59) - Government	Form and Instruction	New
241961	(ePermits) Interstate Commerce Permit Application (Form 3-200-60) - Private Sector	Form and Instruction	New
241959	(ePermits) Interstate Commerce Permit Application (Form 3-200-60) - Individuals	Form and Instruction	New
241958	Interstate Commerce Permit Application (Form 3-200-59) - Government	Form and Instruction	New
241957	Interstate Commerce Permit Application (Form 3-200-60) - Private Sector	Form and Instruction	New
241956	Interstate Commerce Permit Application (Form 3-200-60) - Individuals	Form and Instruction	New
241955	(ePermits) Recovery Permit Application (Form 3-200-59) - Government	Form and Instruction	New
241954	(ePermits) Recovery Permit Application (Form 3-200-59) - Private Sector	Form and Instruction	New
241953	(ePermits) Recovery Permit Application (Form 3-200-59) - Individuals	Form and Instruction	New
241949	Recovery Permit Application (Form 3-200-59) - Government	Form and Instruction	New
241948	Recovery Permit Application (Form 3-200-59) - Private Sector	Form and Instruction	New
241947	Recovery Permit Application (Form 3-200-59) - Individuals	Form and Instruction	New
225267	Habitat Conservation Plan (Plan) - Government		Unchanged
225265	Habitat Conservation Plan (Plan) - Private Sector		Unchanged
225264	Habitat Conservation Plan (Plan) - Individuals		Unchanged
225263	Quarterly Report (Form 3-202-55g Turtle Rehabilitation) - Private Sector	Form and Instruction	Unchanged
225262	Annual Report (Form 3-202-55f Non-Releasable Sea Turtles) - Government	Form and Instruction	Unchanged
225261	Annual Report (Form 3-202-55f Non-Releasable Sea Turtles) - Private Sector	Form and Instruction	Unchanged
225260	Annual Report (Form 3-202-55e Region 6 Bat Reporting) - Government	Form and Instruction	Unchanged
225259	Annual Report (Form 3-202-55e Region 6 Bat Reporting) - Private Sector	Form and Instruction	Unchanged
225258	Annual Report (Form 3-202-55e Region 6 Bat Reporting) - Individuals	Form and Instruction	Unchanged
225257	Annual Report (Form 3-202-55d Region 5 Bat Reporting) - Government	Form and Instruction	Unchanged
225256	Annual Report (Form 3-202-55d Region 5 Bat Reporting) - Private Sector	Form and Instruction	Unchanged
225255	Annual Report (Form 3-202-55d Region 5 Bat Reporting) - Individuals	Form and Instruction	Unchanged
225254	Annual Report (Form 3-202-55c Region 4 Bat Reporting) - Government	Form and Instruction	Unchanged
225253	Annual Report (Form 3-202-55c Region 4 Bat Reporting) - Private Sector	Form and Instruction	Unchanged
225252	Annual Report (Form 3-202-55c Region 4 Bat Reporting) - Individuals	Form and Instruction	Unchanged
225250	Annual Report (Form 3-202-55b Region 3 Bat Reporting) - Government	Form and Instruction	Unchanged
225248	Annual Report (Form 3-202-55b Region 3 Bat Reporting) - Private Sector	Form and Instruction	Unchanged
225247	Annual Report (Form 3-202-55b Region 3 Bat Reporting) - Individuals	Form and Instruction	Unchanged
225246	Recovery/Interstate Commerce (Request to Revise List of Authorized Individuals) - Private Sector		Unchanged
225245	SHA/CCAA (Individual SHA Template) - Government	Instruction	Unchanged
225243	SHA/CCAA (Individual CCAA Template) - Government	Instruction	Unchanged
225171	SHA/CCAA (Individual SHA Template) - Private Sector	Instruction	Unchanged
225170	SHA/CCAA (Individual CCAA Template) - Private Sector	Instruction	Unchanged
225169	SHA/CCAA (Individual SHA Template) - Individuals	Instruction	Unchanged
225168	SHA/CCAA (Individual CCAA Template) - Individuals	Instruction	Unchanged
182003	Habitat Conservation Plan (Annual Report) - Government		Unchanged
182002	Habitat Conservation Plan (Annual Report) - Private Sector		Unchanged
182001	Habitat Conservation Plan (Annual Report) - Individuals		Unchanged
182000	Habitat Conservation Plan (Application Form 300-200-56) - Government	Form and Instruction	Unchanged
181999	Habitat Conservation Plan (Application Form 300-200-56) - Private Sector	Form and Instruction	Unchanged
181998	Habitat Conservation Plan (Application Form 300-200-56) - Individuals	Form and Instruction	Unchanged
181997	Recovery/Interstate Commerce (Notification of Wildlife Escape) - Private Sector		Unchanged
181996	Recovery/Interstate Commerce (Annual Report) - Government		Unchanged
181995	Recovery/Interstate Commerce (Annual Report) - Private Sector		Unchanged
181994	Recovery/Interstate Commerce (Annual Report) - Individuals		Unchanged
181950	Recovery/Interstate Commerce (Application Form 3-200-55) - Government	Form and Instruction	Removed
181949	Recovery/Interstate Commerce (Application Form 3-200-55) - Private Sector	Form and Instruction	Removed
181933	Recovery/Interstate Commerce (Application Form 3-200-55) - Individuals	Form and Instruction	Removed
181932	SHA/CCAA (Notifications - Change in Landowner) - Individuals		Unchanged
181931	SHA/CCAA (Notifications - Incidental Take) - Individuals		Unchanged
181930	SHA/CCAA (Annual Report) - Government		Unchanged
181929	SHA/CCAA (Annual Report) - Private Sector		Unchanged
181928	SHA/CCAA (Annual Report) - Individuals		Unchanged
181911	SHA/CCAA (Application Form 3-200-54) - Government	Form and Instruction	Unchanged
181910	SHA/CCAA (Application Form 3-200-54) - Private Sector	Form and Instruction	Unchanged

ICR Details

OMB Control No: 1018-0094	ICR Reference No: 202005-1018-002
Status: Historical Inactive	Previous ICR Reference No: 201903-1018-003
Agency/Subagency: DOI/FWS	Agency Tracking No:
Title: Federal Fish and Wildlife Permit Applications and Reports - Native Endangered and Threatened Species; 50 CFR 10, 13, and 17
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Improperly submitted and continue	Conclusion Date: 06/01/2020
	Date Received in OIRA: 05/22/2020
Terms of Clearance: The agency is requested to submit the requested changes as part of an information collection request revision package.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2021	03/31/2021	03/31/2021
Responses	4,051	0	4,051
Time Burden (Hours)	114,075	0	114,075
Cost Burden (Dollars)	59,750	0	59,750

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Abstract: The Fish and Wildlife Service collects information on application forms and in reports to determine the eligibility of applicants for permits requested in accordance with the criteria in various Federal wildlife conservation laws. The requirements associated with this information collection implement the prohibitions and exceptions of the Endangered Species Act, except those concerning the Convention on International Trade in Endangered Species of Flora and Fauna (CITES).

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Authorizing Statute(s): US Code: 16 USC 1531 et seq Name of Law: Endangered Species Act
   US Code: 16 USC 703 et seq Name of Law: Migratory Bird Treaty Act
   US Code: 16 USC 3371 et seq Name of Law: Lacey Act
   US Code: 16 USC 668 Name of Law: Bald and Golden Eagle Protection Act
   US Code: 16 USC 1374 Name of Law: Marine Mammal Protection Act
  

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:
	81 FR 68029	12/02/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 8840	01/31/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 55

IC Title	Form No.	Form Name
(ePermits) Recovery Permit Application (Form 3-200-59) - Private Sector	3-200-59	Federal Fish and Wildlife Permit Application Form - Native Endangered and Threatened Species Scientific, Enhancement of Propagation, or Survival (i.e., Purposeful Take for Recovery)
Interstate Commerce Permit Application (Form 3-200-59) - Government	3-200-60	Federal Fish and Wildlife Permit Application Form - Native Endangered and Threatened Species Interstate Commerce
SHA/CCAA (Application Form 3-200-54) - Individuals	3-200-54	Enhancement of Survival Permits Associated with Safe Harbor Agreements and Candidate Conservation Agreements with Assurances
SHA/CCAA (Application Form 3-200-54) - Private Sector	3-200-54	Enhancement of Survival Permits Associated with Safe Harbor Agreement & Candidate Conservation Agreement with Assurances
SHA/CCAA (Application Form 3-200-54) - Government	3-200-54	Enhancement of Survival Permits Associated with Safe Harbor Agreement & Candidate Conservation Agreement with Assurances
SHA/CCAA (Individual CCAA Template) - Individuals
SHA/CCAA (Individual SHA Template) - Private Sector
SHA/CCAA (Annual Report) - Individuals
Recovery/Interstate Commerce (Annual Report) - Individuals
SHA/CCAA (Individual SHA Template) - Government
Annual Report (Form 3-202-55b Region 3 Bat Reporting) - Private Sector	3-202-55b	USFWS R3 Bat Reporting Form Rev 01-2017
Annual Report (Form 3-202-55b Region 3 Bat Reporting) - Government	3-202-55b	USFWS R3 Bat Reporting Form Rev 01-2017
Annual Report (Form 3-202-55c Region 4 Bat Reporting) - Private Sector	3-202-55c	USFWS R4 Bat Reporting Form Rev 01-2017
Annual Report (Form 3-202-55c Region 4 Bat Reporting) - Individuals	3-202-55c	USFWS R4 Bat Reporting Form Rev 01-2017
Annual Report (Form 3-202-55c Region 4 Bat Reporting) - Government	3-202-55c	USFWS R4 Bat Reporting Form Rev 01-2017
Annual Report (Form 3-202-55d Region 5 Bat Reporting) - Individuals	3-202-55d	USFWS R5 Bat Bat Reporting Form Rev 01-2017
Annual Report (Form 3-202-55d Region 5 Bat Reporting) - Private Sector	3202-55d	USFWS R5 Bat Bat Reporting Form Rev 01-2017
Annual Report (Form 3-202-55d Region 5 Bat Reporting) - Government	3-202-55d	USFWS R5 Bat Bat Reporting Form Rev 01-2017
Annual Report (Form 3-202-55e Region 6 Bat Reporting) - Individuals	3-202-55e	USFWS R6 Bat Bat Reporting Form Rev 01-2017
Annual Report (Form 3-202-55e Region 6 Bat Reporting) - Private Sector	3-202-55e	USFWS R6 Bat Bat Reporting Form Rev 01-2017
Annual Report (Form 3-202-55e Region 6 Bat Reporting) - Government	3-202-55e	USFWS R6 Bat Bat Reporting Form Rev 01-2017
Annual Report (Form 3-202-55f Non-Releasable Sea Turtles) - Private Sector	3-202-55f	USFWS Non-Releasable Sea Turtle Annual Report Rev 01-2017
Annual Report (Form 3-202-55f Non-Releasable Sea Turtles) - Government	3-202-55f	USFWS Non-Releasable Sea Turtle Annual Report Rev 01-2017
Quarterly Report (Form 3-202-55g Turtle Rehabilitation) - Private Sector	3-202-55g	USFWS Sea Turtle Rehabilitation Quarterly Report Rev 01-2017
Habitat Conservation Plan (Plan) - Individuals
Habitat Conservation Plan (Plan) - Private Sector
Habitat Conservation Plan (Plan) - Government
Recovery/Interstate Commerce (Annual Report) - Private Sector
Recovery/Interstate Commerce (Annual Report) - Government
Recovery/Interstate Commerce (Notification of Wildlife Escape) - Private Sector
Habitat Conservation Plan (Application Form 300-200-56) - Individuals	3-200-56	Incidental Take Permits Associated with a Habitat Conservation Plan (HCP)
Habitat Conservation Plan (Application Form 300-200-56) - Private Sector	3-200-56	Incidental Take Permits Associated with a Habitat Conservation Plan (HCP)
SHA/CCAA (Individual CCAA Template) - Government
SHA/CCAA (Individual SHA Template) - Individuals
SHA/CCAA (Individual CCAA Template) - Private Sector
Annual Report (Form 3-202-55b Region 3 Bat Reporting) - Individuals	3-202-55b	USFWS R3 Bat Reporting Form Rev 01-2017
Recovery/Interstate Commerce (Request to Revise List of Authorized Individuals) - Private Sector
Habitat Conservation Plan (Application Form 300-200-56) - Government	3-200-56	Incidental Take Permits Associated with a Habitat Conservation Plan (HCP)
Habitat Conservation Plan (Annual Report) - Individuals
Habitat Conservation Plan (Annual Report) - Private Sector
Habitat Conservation Plan (Annual Report) - Government
Recovery/Interstate Commerce (Application Form 3-200-55) - Government	3-200-55	Scientific Purposes, Enhancement of Propagation or Survival Permits and Interstate Commerce Permits
SHA/CCAA (Annual Report) - Government
SHA/CCAA (Annual Report) - Private Sector
SHA/CCAA (Notifications - Incidental Take) - Individuals
SHA/CCAA (Notifications - Change in Landowner) - Individuals
Recovery Permit Application (Form 3-200-59) - Individuals	3-200-59	Federal Fish and Wildlife Permit Application Form - Native Endangered and Threatened Species Scientific, Enhancement of Propagation, or Survival (i.e., Purposeful Take for Recovery)
Recovery Permit Application (Form 3-200-59) - Private Sector	3-200-59	Federal Fish and Wildlife Permit Application Form - Native Endangered and Threatened Species Scientific, Enhancement of Propagation, or Survival (i.e., Purposeful Take for Recovery)
Recovery Permit Application (Form 3-200-59) - Government	3-200-59	Federal Fish and Wildlife Permit Application Form - Native Endangered and Threatened Species Scientific, Enhancement of Propagation, or Survival (i.e., Purposeful Take for Recovery)
Recovery/Interstate Commerce (Application Form 3-200-55) - Individuals	3-200-55	Scientific Purpose, Enhancement of Propagation or Survival Permits - Application
Recovery/Interstate Commerce (Application Form 3-200-55) - Private Sector	3-200-55	Scientific Purposes, Enhancement of Propagation or Survival Permits - Application
(ePermits) Recovery Permit Application (Form 3-200-59) - Individuals	3-200-59	Federal Fish and Wildlife Permit Application Form - Native Endangered and Threatened Species Scientific, Enhancement of Propagation, or Survival (i.e., Purposeful Take for Recovery)
(ePermits) Recovery Permit Application (Form 3-200-59) - Government	3-200-59	Federal Fish and Wildlife Permit Application Form - Native Endangered and Threatened Species Scientific, Enhancement of Propagation, or Survival (i.e., Purposeful Take for Recovery)
Interstate Commerce Permit Application (Form 3-200-60) - Individuals	3-200-60	Federal Fish and Wildlife Permit Application Form - Native Endangered and Threatened Species Interstate Commerce
Interstate Commerce Permit Application (Form 3-200-60) - Private Sector	3-200-60	Federal Fish and Wildlife Permit Application Form - Native Endangered and Threatened Species Interstate Commerce
(ePermits) Interstate Commerce Permit Application (Form 3-200-60) - Individuals	3-200-60	Federal Fish and Wildlife Permit Application Form - Native Endangered and Threatened Species Interstate Commerce
(ePermits) Interstate Commerce Permit Application (Form 3-200-60) - Private Sector	3-200-60	Federal Fish and Wildlife Permit Application Form - Native Endangered and Threatened Species Interstate Commerce
Interstate Commerce Permit Application (Form 3-200-59) - Government	3-200-60	Federal Fish and Wildlife Permit Application Form - Native Endangered and Threatened Species Interstate Commerce

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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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: We are requesting OMB approval to split Form 3-200-55 into two forms: Form 3-200-59, "Recovery Permit Application" and Form 3-200-60, "Interstate Commerce Permit Application." We are also requesting OMB approval to automate both new forms in the Service's ePermits System expected to go live in September, 2020. The requested changes would result in a slight decrease of 160 hours in the approved hourly burden for this collection.

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Annual Cost to Federal Government: $2,582,230

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: 05/22/2020

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