Information Collection

Background Investigations for Child Care Workers, GSA Form 176

IC 190281 under ICR 202110-3090-001 · OMB 3090-0287.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3090-0287 can be found here:

Documents and Forms

Document Name Document Type
Form GSA Form 176 Background Investigations for Child Care Workers, GSA Form 176 Form and Instruction
GSA Form 176 Basic National Agency Check Criminal History (Child Care GSA 176.pdf Form and Instruction
GSA Form 176 Basic National Agency Check Criminal History (Child Care GSA 176.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Background Investigations for Child Care Workers, GSA Form 176	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	GSA Form 176	Basic National Agency Check Criminal History (Child Care Workers)	GSA 176.pdf		Yes	Yes	Fillable Printable

Line of Business: Supply Chain Management

Subfunction: Services Acquisition

Privacy Act System of Records
Title: HSPD-12 USAccess	FR Citation: 80 FR 64416

Number of Respondents: 3,060	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 99 %

	Approved	Previously Approved
Annual Number of Responses for this IC	3,060	3,060
Annual IC Time Burden (Hours)	1,530	1,530
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.