Various contract related forms that will be included in the Homeland Security Acquisition Regulation

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DHS 700-1 Cumulative Claim and Reconciliation Statement	Form	Modified	Repair queued
Form DHS 700-1 Cumulative Claim and Reconciliation Statement	Form	Modified	Repair queued
Form DHS 700-4 Employee Claim for Wage Restitution	Form	Modified	Repair queued
Form DHS 700-4 Employee Claim for Wage Restitution	Form	Modified	Repair queued
Form DHS 700-3 Contractor's Release	Form	Modified	Available
Form DHS 700-3 Contractor's Release	Form	Modified	Repair queued
Form DHS 700-2 Contractors Assignment of Refunds, Rebates, Credits, and Other Amounts	Form	Modified	Repair queued
Form DHS 700-2 Contract Assignment of Refunds, Rebates, Credits and Other Amounts	Form	Modified	Repair queued
30 Day FRN 1600-0002 04122021.pdf	Supplementary Document	Uploaded 2021-05-14	Repair queued
60 Day FRN 1600-0002 11162020.pdf	Supplementary Document	Uploaded 2021-05-14	Available
1600-0002_Supporting_Statement 05142021.docx	Supporting Statement A	Uploaded 2021-05-19	Available
FAR 48 CFR.pdf	Supplementary Document	Uploaded 2007-12-17	Repair queued
HSAR-0606.pdf	Supplementary Document	Uploaded 2007-12-12	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
20201	Cumulative Claim and Reconciliation Statement	Form	Modified	Cumulative Claim and Reconciliation Statement
20201	Cumulative Claim and Reconciliation Statement	Form	Modified
182985	Employee Claim for Wage Restitution	Form	Modified	Employee Claim for Wage Restitution
182985	Employee Claim for Wage Restitution	Form	Modified
182984	Contractor's Release	Form	Modified	Contractor's Release
182984	Contractor's Release	Form	Modified
182983	Contract Assignment of Refunds, Rebates, Credits and Other Amounts	Form	Modified	Contractors Assignment of Refunds, Rebates, Credits, and Other Amounts
182983	Contract Assignment of Refunds, Rebates, Credits and Other Amounts	Form	Modified

ICR Details

OMB Control No: 1600-0002	ICR Reference No: 202105-1600-001
Status: Historical Active	Previous ICR Reference No: 201806-1600-001
Agency/Subagency: DHS	Agency Tracking No:
Title: Various contract related forms that will be included in the Homeland Security Acquisition Regulation
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 without change	Conclusion Date: 05/24/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/30/2021
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2025	36 Months From Approved	05/31/2022
Responses	34,013	0	56,238
Time Burden (Hours)	34,013	0	56,238
Cost Burden (Dollars)	0	0	0

---

Abstract: This information collection associated with the forms are necessary in order to implement applicable parts of the Homeland Security Acquisition Regulation (HSAR) (48 CFR Chapter 30). The forms under this collection of information request are used by offerors, contractors, and the general public to comply with requirements in contracts awarded by the Department of Homeland Security (DHS) and the information collected is used by contracting officers to ensure compliance with terms and conditions of DHS contracts. These forms will be used by contractors and/or contract employees during contract administration to collect the following: DHS Forms 0700-01, 0700-02 and 0700-03 are used to collect information when applicable and prior to contract closure to determine whether there are excess funds are available for deobligation versus remaining (payable) funds on contracts; assignment or transfer all rights, title, and interest to the Government; and release from liability. The contracting officer obtains the listed DHS Forms 0700-01, 0700-02 and 0700-03 from the contractor for closeout, as applicable. DHS Form 0700-04 is used by contractor employees for claims for unpaid wages.

---

Authorizing Statute(s): US Code: 41 USC 401 Name of Law: Office of Federal Procurement Policy Act of 1974
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 73065	11/16/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 19004	04/12/2021
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Contract Assignment of Refunds, Rebates, Credits and Other Amounts	DHS 700-2	Contractors Assignment of Refunds, Rebates, Credits, and Other Amounts
Contractor's Release	DHS 700-3	Contractor's Release
Cumulative Claim and Reconciliation Statement	DHS 700-1	Cumulative Claim and Reconciliation Statement
Employee Claim for Wage Restitution	DHS 700-4	Employee Claim for Wage Restitution

---

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	34,013	56,238	0	0	-22,225	0
Annual Time Burden (Hours)	34,013	56,238	0	0	-22,225	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The burden estimates provided in response to Item 12 above are based upon contracts reported by DHS and its Components to the FPDS for Fiscal Year 2019. No program changes occurred and there were no changes to the information being collected. However, the burden was adjusted to reflect an agency adjustment decrease of 22,225 in the number of respondents within DHS for Fiscal Year 2019, and an increase in the average hourly wage rate.

---

Annual Cost to Federal Government: $1,746,567

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.     No

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

---

Common Form ICR:  No

---

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: 06/30/2021

---