Personal Information Questionnaire

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form NAVMC Form 10064 Personal Information Questionnaire	Form and Instruction	Modified	Available
Form NAVMC Form 10064 Personal Information Questionnaire	Form and Instruction	Modified	Repair queued
0703-0012_Supporting Email_6.9.2022.docx	Supplementary Document	Uploaded 2022-06-14	Available
0703-0012_SSA_6.30.2022.docx	Supporting Statement A	Uploaded 2022-06-30	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
5207	Personal Information Questionnaire	Form and Instruction	Modified	Personal Information Questionnaire
5207	Personal Information Questionnaire	Form and Instruction	Modified

ICR Details

OMB Control No: 0703-0012	ICR Reference No: 202206-0703-002
Status: Historical Active	Previous ICR Reference No: 201905-0703-002
Agency/Subagency: DOW/NAVY	Agency Tracking No: 0703-0012
Title: Personal Information Questionnaire
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/04/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/30/2022
Terms of Clearance: This collection is approved based on the revised materials provided by the Department.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2025	36 Months From Approved	08/31/2022
Responses	3,500	0	3,500
Time Burden (Hours)	875	0	875
Cost Burden (Dollars)	18,270	0	14,210

---

Abstract: The information collected through NAVMC Form 10064, “Personal Information Questionnaire” is needed to verify a potential officer candidate’s moral character. Information pertaining to an applicant’s moral character is of the utmost importance when applying for a program. As a commissioned officer in the United States Marine Corps, these men and women will be expected to lead others by example, upholding the Marine Corps Values of honor, courage, and commitment. They will have Marines under their charge, and will be expected to be of the finest moral character.

---

Authorizing Statute(s): US Code: 10 USC 12209 Name of Law: Officer Candidates
  

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:
	87 FR 17283	03/28/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 39073	06/30/2022
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Personal Information Questionnaire	NAVMC Form 10064	Personal Information Questionnaire

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	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	3,500	3,500	0	0	0	0
Annual Time Burden (Hours)	875	875	0	0	0	0
Annual Cost Burden (Dollars)	18,270	14,210	0	4,060	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:

---

Annual Cost to Federal Government: $16,634

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

---

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: 06/30/2022

---