USM-164 Applicant Appraisal Questionnaire

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form USM-164 USMS Applicant Appraisal Questionnaire	Form and Instruction	Modified	Available
Form Form USM-164 Form USM-164 - USMS Applicant Appraisal Questionnaire	Form and Instruction	Modified	Repair queued
1105-0106 - Supporting-Statement.docx	Supporting Statement A	Uploaded 2021-09-22	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
231921	Form USM-164 - USMS Applicant Appraisal Questionnaire	Form and Instruction	Modified	USMS Applicant Appraisal Questionnaire
231921	Form USM-164 - USMS Applicant Appraisal Questionnaire	Form and Instruction	Modified

ICR Details

OMB Control No: 1105-0106	ICR Reference No: 202107-1105-001
Status: Historical Active	Previous ICR Reference No: 201707-1105-001
Agency/Subagency: DOJ/LA	Agency Tracking No:
Title: USM-164 Applicant Appraisal Questionnaire
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: 02/03/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/29/2021
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2025	36 Months From Approved	02/28/2022
Responses	1,500	0	1,500
Time Burden (Hours)	500	0	500
Cost Burden (Dollars)	20,745	0	20,745

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Abstract: This form is used to collect applicant reference information. Reference checking is an objective evaluation of an applicant’s past job performance based on information collected from key individuals (e.g. supervisors, peers, subordinates) who have known and worked with the applicant. Reference checking is a necessary supplement to the evaluation of resumes and other descriptions of training and experience, and allows the selecting official to hire applicants with a strong history of performance. The questions on this form have been developed following the OPM, MSPB, and DOJ “Best Practice” guidelines for reference checking.

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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

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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:
	86 FR 39078	07/23/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 53681	09/28/2021
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
Form USM-164 - USMS Applicant Appraisal Questionnaire	Form USM-164	USMS Applicant Appraisal Questionnaire

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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	1,500	1,500	0	1,000	-1,000	0
Annual Time Burden (Hours)	500	500	0	333	-333	0
Annual Cost Burden (Dollars)	20,745	20,745	0	0	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: Human Resources has estimated that they will interview more references per year than previously estimated based on current hiring rates.

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Annual Cost to Federal Government: $20,745

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: 10/29/2021

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