Impact Assessment Questionnaire

Forms and Documents

Document Name	Status
Form DFC-007a Impact Assessment Questionnaire: COVID-19 Response Version Form and Instruction	Unchanged
Form DFC-007 Impact Assessment Questionnaire Form and Instruction	Unchanged
DFC-007 - Justification for Non-Substantive Change.docx Justification for No Material/Nonsubstantive Change	2022-02-18
DFC-007 OMB - OIG clean.docx Supplementary Document	2022-02-18
Response to Comments_Form 007_FINAL_100920_cfa signed.docx Supplementary Document	2020-11-09
83-I Questionnaire -- 007_Final_cfa signed.docx Supplementary Document	2020-11-09
Supporting Statement for 007_Final.docx Supporting Statement A	2020-11-09
DFC-007a - Justification for Non-Substantive Change.docx Justification for No Material/Nonsubstantive Change	2020-04-28

IC Document Collections

IC ID	Document Title	Status
241586	Impact Assessment Questionnaire: COVID-19 Response Version Form and Instruction	Unchanged
236742	Impact Assessment Questionnaire Form and Instruction	Unchanged

ICR Details

OMB Control No: 3015-0009	ICR Reference No: 202202-3015-006
Status: Received in OIRA	Previous ICR Reference No: 202011-3015-001
Agency/Subagency: DFC	Agency Tracking No: DFC‐007
Title: Impact Assessment Questionnaire
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 02/18/2022

	Requested	Previously Approved
Expiration Date	02/29/2024	02/29/2024
Responses	275	275
Time Burden (Hours)	695	695
Cost Burden (Dollars)	19,783	19,783

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Abstract: The DFC Impact Assessment Questionnaire is the principal document used by the agency to initiate the assessment of the project’s development impact, as well as the project’s ability to comply with environmental and social policies, including labor and human rights, as consistent with the agency’s authorizing legislation.

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Authorizing Statute(s): US Code: 22 USC 9601 et al Name of Law: Better Utilization of Investments Leading to Development
  

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:
	85 FR 41573	07/10/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 68059	10/27/2020
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Impact Assessment Questionnaire	DFC-007	Impact Assessment Questionnaire
Impact Assessment Questionnaire: COVID-19 Response Version	DFC-007a	Impact Assessment Questionnaire: COVID-19 Response Version

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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	275	275	0	0	0	0
Annual Time Burden (Hours)	695	695	0	0	0	0
Annual Cost Burden (Dollars)	19,783	19,783	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The annual burden is an increase from previous claimed burden as the form is more comprehensive to be in line with new reporting requirements and to best serve the newly created performance measurement system as dictated by statute.

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Annual Cost to Federal Government: $14,532

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

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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: 02/18/2022

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