Grantee Conflicts of Interest Disclosure Form

Forms and Documents

Document Name	Status
Grantee Conflicts of Interest Disclosure Form PRA Supporting Statement.docx Supporting Statement A	2021-08-25
Grantee Conflicts of Interest Disclosure Form.docx Supplementary Document	2021-08-25

IC Document Collections

IC ID	Document Title	Status
249067	Grantee Conflicts of Interest Disclosure Form	New

ICR Details

OMB Control No:	ICR Reference No: 202108-0417-001
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: IAF	Agency Tracking No:
Title: Grantee Conflicts of Interest Disclosure Form
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 08/27/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	10	0
Time Burden (Hours)	15	0
Cost Burden (Dollars)	230	0

---

Abstract: The purpose of this Information Collection (ICR) request is required to ensure that the Inter-American Foundation (IAF or the Agency) can effectively identify, evaluate, and take appropriate action concerning IAF grantee conflicts of interest. Using the Grantee Conflicts of Interest Disclosure Form (or “Disclosure Form”), IAF grantees must disclose any actual or perceived personal or organization conflicts of interest or potential conflicts of interest. Also, IAF grantees must have written conflict of interest policies in place within the first six (6) months of their grant periods to (1) ensure all employees, board members, officers, or agents engaged in the award and administration of IAF grants, (2) avoid personal and organizational conflicts of interest, and (3) to prevent the use of positions for one’s own personal gain or the gain of persons or organizations with which one is associated personally.

---

Authorizing Statute(s): None

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 24655	05/07/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 46866	08/20/2021
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Grantee Conflicts of Interest Disclosure Form

---

ICR Summary 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	10	0	0	10	0	0
Annual Time Burden (Hours)	15	0	0	15	0	0
Annual Cost Burden (Dollars)	230	0	0	230	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: This is a new IC collection and burden has not increased

---

Annual Cost to Federal Government: $1,800

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: 08/27/2021

---