CSO-005 - Preliminary Background Check Form

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CSO-005 Form CSO-005, Preliminary Background Check Form	Form and Instruction	Unchanged	Missing upstream
New Collection - CSO-005 - Supporting Statement.doc	Supporting Statement A	Uploaded 2018-04-23	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
231179	Form CSO-005, Preliminary Background Check Form	Form and Instruction	Unchanged

ICR Details

OMB Control No: 1105-0105	ICR Reference No: 202106-1105-001
Status: Received in OIRA	Previous ICR Reference No: 201801-1105-001
Agency/Subagency: DOJ/LA	Agency Tracking No:
Title: CSO-005 - Preliminary Background Check Form
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/29/2021

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	10/31/2021
Responses	750	750
Time Burden (Hours)	1,125	1,125
Cost Burden (Dollars)	14,651	14,651

---

Abstract: The CSO-005 Preliminary Background Check Form is used to collect applicant information for CSO/SSO positions. The applicant information provided to USMS from the Vendor gives information about which District and Facility the applicant will be working, the applicant’s personal information, prior employment verification, employment performance and current financial status. The information allows the selecting official to hire applicants with a strong history of employment performance and financial responsibility. The questions on this form have been developed from the OPM, MSPB and DOJ “Best Practice” guidelines for reference checking.

---

Authorizing Statute(s): US Code: 5 USC 3301 Name of Law: Civil service; generally
   US Code: 28 USC 561 Name of Law: United States Marshals Service
  

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:
	86 FR 34279	06/29/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 57445	10/15/2021
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Form CSO-005, Preliminary Background Check Form	CSO-005	Preliminary Background Check Form

---

ICR Summary of Burden

table that charts list of burden

	Total Request	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	750	750	0	0	0	0
Annual Time Burden (Hours)	1,125	1,125	0	0	0	0
Annual Cost Burden (Dollars)	14,651	14,651	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:

---

Annual Cost to Federal Government: $976

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

---

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: 10/29/2021

---