Government, Corporate or Foundation, and Individual Donor Form Application

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DS-4273 Donor Form - Individual	Form and Instruction	Modified	Available
Form DS-4272 Donor Form - Corporate or Foundation	Form and Instruction	Modified	Available
Form DS-4271 Donor Form - Government	Form and Instruction	Modified	Available
Form DS-4271 Government, Corporate or Foundation, and Individual Donor Form Applications	Form and Instruction	Modified	Repair queued
Legal Authorities.docx	Supplementary Document	Uploaded 2020-11-10	Repair queued
Final Supporting Statement.docx	Supporting Statement A	Uploaded 2020-11-10	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
214454	Government, Corporate or Foundation, and Individual Donor Form Applications	Form and Instruction	Modified	Donor Form - Individual
214454	Government, Corporate or Foundation, and Individual Donor Form Applications	Form and Instruction	Modified	Donor Form - Corporate or Foundation
214454	Government, Corporate or Foundation, and Individual Donor Form Applications	Form and Instruction	Modified	Donor Form - Government
214454	Government, Corporate or Foundation, and Individual Donor Form Applications	Form and Instruction	Modified

ICR Details

OMB Control No: 1405-0218	ICR Reference No: 202011-1405-001
Status: Historical Active	Previous ICR Reference No: 201710-1405-002
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Government, Corporate or Foundation, and Individual Donor Form Application
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 with change	Conclusion Date: 03/26/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/10/2020
Terms of Clearance: The agency made clarifying edits to the supporting statement. The agency also now allows for electronic submission via email.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2024	36 Months From Approved	03/31/2021
Responses	4,079	0	4,333
Time Burden (Hours)	680	0	361
Cost Burden (Dollars)	2,243	0	2,123

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Abstract: The Office of Emergencies in the Diplomatic and Consular Services (EDCS) manages the solicitation and acceptance of gifts to the U.S. Department of State. The information requested via donor forms is a necessary first step in accepting donations. The information sought is pursuant to 22 U.S.C 2697, 5 U.S.C. 7342 and 22 CFR, Part 3.

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Authorizing Statute(s): US Code: 5 USC 7342 Name of Law: Foreign Gifts and Decorations Act
   US Code: 22 USC 2697 Name of Law: State Department Basic Authorities Act of 1956
  

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 47285	08/04/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 71390	11/09/2020
Did the Agency receive public comments on this ICR? Yes

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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
Government, Corporate or Foundation, and Individual Donor Form Applications	DS-4271, DS-4272, DS-4273	Donor Form - Government ,   Donor Form - Corporate or Foundation ,   Donor Form - Individual

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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	4,079	4,333	0	-254	0	0
Annual Time Burden (Hours)	680	361	0	319	0	0
Annual Cost Burden (Dollars)	2,243	2,123	0	120	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: Since the previous renewal, donations from government, individuals, corporations, and foundations slightly decreased by 6%. Donations vary due to political, environmental, and economic stability.

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Annual Cost to Federal Government: $101,699

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.     No

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: 11/10/2020

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