MTU Intake Questionnaire

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DFC-015 MTU Intake Questionnaire (for Non-Financial Institutions)	Form and Instruction	New	Available
Form DFC-015 MTU Intake Questionnaire (for Financial Institutions)	Form and Instruction	New	Available
Form DFC-015 MTU Intake Questionnaire	Form and Instruction	New	Repair queued
DFC-015 83-I signed.pdf	Supplementary Document	Uploaded 2021-01-19	Repair queued
DFC-015 Supporting Statement FINAL.pdf	Supporting Statement A	Uploaded 2021-01-19	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
245386	MTU Intake Questionnaire	Form and Instruction	New	MTU Intake Questionnaire (for Non-Financial Institutions)
245386	MTU Intake Questionnaire	Form and Instruction	New	MTU Intake Questionnaire (for Financial Institutions)
245386	MTU Intake Questionnaire	Form and Instruction	New

ICR Details

OMB Control No: 3015-0016	ICR Reference No: 202101-3015-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DFC	Agency Tracking No: DFC-015
Title: MTU Intake Questionnaire
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/07/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/19/2021
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2024	36 Months From Approved
Responses	130	0	0
Time Burden (Hours)	130	0	0
Cost Burden (Dollars)	9,750	0	0

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Abstract: The MTU Intake Questionnaire is the principal document used to collect information from potential clients seeking support from the Mission Transaction Unit (MTU) of DFC. MTU works together with USAID missions and operating units to promote and advance the agencies' development objectives around the world.

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Authorizing Statute(s): PL: Pub.L. 115 - 254 205 Name of Law: BUILD Act of 2018
  

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 51684	08/21/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 68859	10/30/2020
Did the Agency receive public comments on this ICR? No

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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
MTU Intake Questionnaire	DFC-015, DFC-015	MTU Intake Questionnaire (for Financial Institutions) ,   MTU Intake Questionnaire (for Non-Financial Institutions)

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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	130	0	0	130	0	0
Annual Time Burden (Hours)	130	0	0	130	0	0
Annual Cost Burden (Dollars)	9,750	0	0	9,750	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: Increase as this is a new information collection.

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Annual Cost to Federal Government: $7,556

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: 01/19/2021

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