Supplemental Intelligence Background Questions

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form PC-1336S Supplemental Intelligence Background Questions	Form and Instruction	New	Repair queued
SORN PC-28 Applications for Employment.pdf	Supplementary Document	Uploaded 2024-12-06	Repair queued
SORN PC-08 Legal Files - Staff, Volunteers, and Applicants.pdf	Supplementary Document	Uploaded 2024-12-06	Repair queued
Supplemental Intelligence Background Questions Supporting Statement A.docx	Supporting Statement A	Uploaded 2024-12-06	Repair queued
PC-1336 Intelligence Background Questionnaire Rev Sep 2022 - Final.pdf	Supplementary Document	Uploaded 2024-12-05	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
272821	Supplemental Intelligence Background Questions	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202112-0420-002
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: PEACE	Agency Tracking No: PC-1336S
Title: Supplemental Intelligence Background Questions
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: 12/06/2024

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	100	0
Time Burden (Hours)	17	0
Cost Burden (Dollars)	0	0

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Abstract: The Peace Corps must determine if any incoming federal employees, political appointees, contractors, or interns have an immediate professional affiliation with the Intelligence Community, as this would be a conflict of interest. This form asks additional questions as part of the hiring process for consideration. This form will only be used if the applicant answers yes on the Intelligence Background Questionnaire (OMB 0420-0551).

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Authorizing Statute(s): US Code: 22 USC 2501 Name of Law: The Peace Corps Act of 1961, as amended
  

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:
	89 FR 73453	09/10/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 97079	12/06/2024
Did the Agency receive public comments on this ICR? Yes

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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
Supplemental Intelligence Background Questions	PC-1336S	Supplemental Intelligence Background Questions

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ICR Summary of Burden

table that charts list 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	100	0	0	100	0	0
Annual Time Burden (Hours)	17	0	0	17	0	0
Annual Cost Burden (Dollars)	0	0	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: This is a new form to supplement PC-1336, Intelligence Background Questionnaire. The questions will provide greater context on the applicant's relationship with an intelligence agency which will allow the Peace Corps to make a final decision on employment. The form will only be used if the applicant states 'yes' on the Intelligence Background Questionnaire.

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Annual Cost to Federal Government: $14,478

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: 12/06/2024

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