1105-0106 - Supporting-Statement

1105-0106 - Supporting-Statement.docx

USM-164 Applicant Appraisal Questionnaire

OMB: 1105-0106

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Supporting Statement for Paperwork Reduction Act Submissions


Each information collection request must include a supporting statement outlining the justification for the proposed collection. Completed supporting statement documents must include both the questions below and the component’s answers, even if a question is not applicable. If selecting “Yes” on question 17 of OMB Form 83-I or if selecting in ROCIS that the collection will employ statistical methods, then Part B of the Supporting Statement must also be completed.

  1. Explain the circumstances that make the collection of information necessary. Identify any legal or administrative requirements that necessitate the collection. Attach a copy of the appropriate section of each statute and regulation mandating or authorizing the collection of information.

The USM-164 Applicant Appraisal Questionnaire is the tool for conducting employment reference checks that will be used to determine the applicant’s qualifications and suitability to work for the United States Marshals Service. The U.S. Government is authorized to ask for this information under 5 U.S.C. 3301 and 28 U.S.C. 561.

3301. Civil service; generally The President may

(1) prescribe such regulations for the admission of individuals into the civil service in the executive branch as will best promote the efficiency of that service;

(2) ascertain the fitness of applicants as to age, health, character, knowledge, and ability for the employment sought; and

(3) appoint and prescribe the duties of individuals to make inquiries for the purpose of this section.

561. United States Marshals Service

(a) There is hereby established a United States Marshals Service as a bureau within the Department of Justice under the authority and direction of the Attorney General. There shall be at the head of the United States Marshals Service (hereafter in this chapter referred to as the ‘‘Service’’) a Director who shall be appointed by the President, by and with the advice and consent of the Senate.

(b) The Director of the United States Marshals Service (hereafter in this chapter referred to as the ‘‘Director’’) shall, in addition to the powers and duties set forth in this chapter, exercise such other functions as may be delegated by the Attorney General.

(c) – (e) not applicable

(f) The Director is authorized to appoint and fix the compensation of such employees as are necessary to carry out the powers and duties of the Service and may designate such employees as law enforcement officers in accordance with such policies and procedures as the Director shall establish pursuant to the applicable provisions of title 5 and regulations issued thereunder.

(g) The Director shall supervise and direct the United States Marshals Service in the performance of its duties.

(i) not applicable

  1. Indicate how, by whom, and for what purpose the information is to be used. Except for a new collection, indicate the actual use the agency has made of the information received from the current collection.

The United States Marshals Service Human Resources Division will use the information collected on the USM-164 to validate suitability for Federal employment.


  1. Describe whether, and to what extent, the collection of information involves the use of automated, electronic, mechanical, or other technological collection techniques or other forms of information technology.

The collection of information via the USM-164 does not currently use automated collection techniques.


  1. Describe efforts to identify duplication. Show specifically why any similar information already available cannot be used or modified for use for the purposes described in Item 2 above.

The USM-164 is used as a tool in the Federal recruitment process to validate employment suitability and the information being requested is not duplicated.


  1. If the collection of information impacts small businesses or other small entities (Item 5 of OMB Form 83-I), describe any methods used to minimize burden.

Not applicable. The form is specific to individual applicants, not small businesses.


  1. Describe the consequence to the Federal program or policy activities if the collection is not conducted or is conducted less frequently, as well as any technical or legal obstacles to reducing burden.

The USMS is required to validate information about the work history, experience and the like for Federal employment. As such, not collecting the information on the USM-164 will prevent hiring from occurring.


  1. Explain any special circumstances that require the collection to be conducted in a manner inconsistent with OMB guidelines: (a) requiring respondents to report information to the agency more often than quarterly; (b) requiring respondents to prepare a written response to a collection of information in fewer than 30 days after receipt of it; (c) requiring respondents to submit more than an original and two copies of any document; (d) requiring respondents to retain records, other than health, medical government contract, grant-in-aid, or tax records, for more than three years; (e) in connection with a statistical survey, that is not designed to produce valid and reliable results that can be generalized to the universe of study; (f) requiring the use of statistical data classification that has not been reviewed and approved by OMB; (g) that includes a pledge of confidentially that is not supported by authority established in stature of regulation, that is not supported by disclosure and data security policies that are consistent with the pledge, or which unnecessarily impedes sharing of data with other agencies for compatible confidential use; (h) requiring respondents to submit proprietary trade secrets or other confidential information unless the agency can demonstrate that it has instituted procedures to protect the information’s confidentiality to the extent permitted by law.

None of the above special circumstances apply to this information collection.


  1. If applicable, provide a copy and identify the date and page number of publication in the Federal Register of the agency's notice, required by 5 CFR 1320.8(d), soliciting comments on the information collection prior to submission to OMB. Summarize public comments received in response to that notice and describe actions taken by the agency in response to these comments. Specifically address comments received on cost and hour burden. Describe efforts to consult with persons outside the agency to obtain their views on the availability of data, frequency of collection, the clarity of instructions and recordkeeping, disclosure, or reporting format (if any), and on the data elements to be recorded, disclosed, or reported. Consultation with representatives of those from whom information is to be obtained or those who must compile records should occur at least once every 3 years - even if the collection of information activity is the same as in prior periods. There may be circumstances that may preclude consultation in a specific situation. These circumstances should be explained.

URL to 60-Day Federal Register Notice: https://www.federalregister.gov/documents/2021/07/23/2021-15718/agency-information-collection-activities-proposed-ecollection-ecomments-requested-extension-without

No comments were received from the public.


  1. Explain any decision to provide any payment or gift to respondents, other than remuneration of contractors or grantees.

Not applicable.


  1. Describe any assurance of confidentiality provided to respondents and the basis for the assurance in statute, regulation, or agency policy.

Assurances of confidentiality are provided by the inclusion of Privacy Act of 1974 Compliance information on the form and the declaration that the information contained on the form may be disclosed in accordance with routine disclosures set forth in the Office of Personnel Management, Government-wide system of records, OPM/Gov-1, General Personnel Records, 76 Federal Register 32997 (June 7, 2011).


  1. Provide additional justification for any questions of a sensitive nature, such as sexual behavior and attitudes, religious beliefs, and other matters that are commonly considered private. This justification should include the reasons why the agency considers the questions necessary, the specific uses to be made of the information, the explanation to be given to persons from whom the information is requested, and any steps to be taken to obtain their consent.

The USM-164 does not ask questions of this kind of “sensitive nature”, it only collects information pertinent to ascertaining an applicant’s suitability for employment; specifically, applicants are asked to provide their education, training, employment, and any criminal history in the past 10 years as included in the public job announcement.


  1. Provide estimates of the hour burden of the collection of information. The statement should:

    • Indicate the number of respondents, frequency of response, annual hour burden, and an explanation of how the burden was estimated. Unless directed to do so, agencies should not conduct special surveys to obtain information on which to base hour burden estimates. Consultation with a sample (fewer than 10) of potential respondents is desirable. If the hour burden on respondents is expected to vary widely because of differences in activity, size, or complexity, show the range of estimated hour burden, and explain the reasons for the variance. Generally, estimates should not include burden hours for customary and usual business practices.

    • If this request for approval covers more than one form, provide separate hour burden estimates for each form and aggregate the hour burdens in Item 13 of OMB Form 83-I.

    • Provide estimates of annualized cost to respondents for the hour burdens for collections of information, identifying and using appropriate wage rate categories. The cost of contracting out or paying outside parties for information collection activities should not be included here. Instead, this cost should be included in Item 13.

There is no cost to respondents. The USM-164 is completed by USMS employees who are contacting applicant references and former supervisors. It is estimated it will take the Federal Government 20 minutes to complete the applicant reference check process using the USM-164. At an average hourly rate of $41.50/hr., the estimated cost to process each form is $13.83 per contact made. Three references are checked per applicant. As such, the cost per applicant is estimated at $41.49. The method used to estimate cost comes from actual experience utilizing this form.


  1. Provide an estimate for the total annual cost burden to respondents or record-keepers resulting from the collection of information. (Do not include the cost of any hour burden shown in Items 12 and 14)

As documentation for the Federal employment process, the United States Marshals Service is required to retain the USM-164 for a period not to exceed three years per guidance promulgated by the National Archives and Records Administration and in compliance with Office of Personnel Management Audit requirements. Since the USM-164 is retained electronically, there is limited to no annual cost burden to record-keepers.


  1. The cost estimate should be split into two components: (a) a total capital and start-up cost component (annualized over its expected useful life) and (b) a total operation and maintenance and purchase of services component. The estimates should take into account costs associated with generating, maintaining, and disclosing or providing the information. Include descriptions of methods used to estimate major cost factors including system and technology acquisition, expected useful life of capital equipment, the discount rate(s), and the time period over which costs will be incurred. Capital and start-up costs include, among other items, preparations for collecting information such as purchasing computers and software; monitoring, sampling, drilling and testing equipment; and record storage facilities.

    • If cost estimates are expected to vary widely, agencies should present ranges of cost burdens and explain the reasons for the variance. The cost of purchasing or contracting out information collection services should be a part of this cost burden estimate. In developing cost burden estimates, agencies may consult with a sample of respondents (fewer than 10), utilize the 60-day pre-OMB submission public comment process and use existing economic or regulatory impact analysis associated with the rulemaking containing the information collection, as appropriate.

    • Generally, estimates should not include purchases of equipment or services, or portions thereof, made:

      • Prior to October 1, 1995,

      • To achieve regulatory compliance with requirements not associated with the information collection,

      • For reasons other than to provide information or keep records for the government, or

      • As part of customary and usual business or private practices.

Not applicable.


  1. Provide estimates of annualized costs to the Federal government. Also provide a description of the method used to estimate cost, which should include quantification of hours, operational expenses (such as equipment, overhead, printing, and support staff), and any other expense that would not have been incurred without this collection of information. Agencies may also aggregate cost estimates from Items 12, 13, and 14 in a single table.

See response provided for Item 12.


  1. Explain the reasons for any program changes or adjustments reported in Items 13 or 14 of the OMB Form 83-I.

Not applicable.


  1. For collections of information whose results will be published, outline plans for tabulation and publication. Address any complex analytical techniques that will be used. Provide the time schedule for the entire project, including beginning and ending dates of the collection of information, completion of report, publication dates, and other actions.

Not applicable.


  1. If seeking approval to not display the expiration date for OMB approval of the information collection, explain the reasons that display would be inappropriate.

Not applicable.


  1. Explain each exception to the certification statement identified in Item 19,"Certification for Paperwork Reduction Act Submissions," of OMB Form 83-I.

Not applicable.



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorLynn Bryant
File Modified0000-00-00
File Created2021-11-02

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