Background Investigations for Child Care Workers, GSA Form 176

ICR 202110-3090-001

OMB: 3090-0287

Federal Form Document

Forms and Documents
Form and Instruction
Supporting Statement A
IC Document Collections
ICR Details
3090-0287 202110-3090-001
Received in OIRA 201810-3090-005
Background Investigations for Child Care Workers, GSA Form 176
Extension without change of a currently approved collection   No
Regular 10/06/2021
  Requested Previously Approved
36 Months From Approved 11/30/2021
3,060 3,060
1,530 1,530
0 0

Homeland Security Presidential Directive (HSPD) 12 “Policy for a Common Identification Standard for Federal Employees and Contractors” (the Directive) requires the implementation of a government-wide standard for secure and reliable forms of identification for Federal employees and contractors. OMB’s implementing instructions requires all contract employees requiring routine access to federally controlled facilities for greater than 6 months to receive a background investigation. The minimum background investigation is the Tier 1 and the Office of Personnel Management offers a Tier 1C for childcare. However, there is no requirement in the law or HSPD-12 that requires childcare employees to be subject to the Tier 1C since employees of childcare providers are neither government employees nor government contractors. The childcare providers are required to complete the criminal history background checks mandated in the Crime Control Act of 1990, Pub. L. 101-647, dated November 29, 1990, as amended by Pub. L. 102-190, dated December 5, 1991. These statutes require that each employee of a childcare center located in a Federal building or in leased space must undergo a background check that is: 1) based on fingerprints taken by a law enforcement officer and on other identifying information, 2) conducted through the FBI's Identification Division and through the State criminal history repositories in each state in which the childcare employee has been a resident or has listed in an employment application, and 3) initiated through the personnel program of the applicable employing agency. According to GSA policy childcare workers (as described above) will need to submit the following: 1. An original signed copy of a Basic National Agency Check Criminal History, GSA Form 176; and 2. Two (2) sets of fingerprints on Form SF-87 and /or electronic prints from an enrollment center 3. Electronically submit the e-QIP (SF85) application for completion of the Tier 1C


Not associated with rulemaking

  86 FR 40843 07/29/2021
86 FR 55614 10/06/2021

IC Title Form No. Form Name
Background Investigations for Child Care Workers, GSA Form 176 GSA Form 176 Basic National Agency Check Criminal History (Child Care Workers)

  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 3,060 3,060 0 0 0 0
Annual Time Burden (Hours) 1,530 1,530 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0

Phil Ahn 202 501-2447


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:
    (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;
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.

© 2021 | Privacy Policy