Contractor Information Worksheet; GSA Form 850

ICR 202207-3090-006

OMB: 3090-0283

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2022-08-01
IC Document Collections
ICR Details
3090-0283 202207-3090-006
Received in OIRA 201907-3090-003
GSA
Contractor Information Worksheet; GSA Form 850
Extension without change of a currently approved collection   No
Regular 08/01/2022
  Requested Previously Approved
36 Months From Approved 09/30/2022
25,000 25,000
6,250 6,250
248,625 248,625

Information collected through the Contractor Information Worksheet is necessary to meet: • The Office of Management and Budget (OMB) Guidance M-05-24 for Homeland Security Presidential Directive (HSPD) 12 which authorizes Federal departments and agencies to ensure that contractors have limited/controlled access to facilities and information systems, and • GSA Directive CIO P 2181.1 Homeland Security Presidential Directive-12 Personal Identity Verification and Credentialing which states that GSA contractors must undergo a minimum of a FBI National Criminal Information Check (NCIC) to receive unescorted physical access. GSA requires the collection of the information in the Contractor Information Worksheet to authorize and initiate background check requests for GSA contractors and to obtain a GSA Access Card. The background checks are carried out by the Office of Personnel Management, Facilities, Security & Contracting-Personnel Security (OPM FSC) and the credentialing process is carried out by the GSA’s Managed Service Office (MSO) in accordance with the terms and conditions of separate Memoranda of Agreement (MOAs).

None
None

Not associated with rulemaking

  87 FR 23863 04/21/2022
87 FR 45775 07/29/2022
No

1
IC Title Form No. Form Name
Contractor Information Worksheet, GSA Form 850 GSA 850 Contractor Information Worksheet

  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 25,000 25,000 0 0 0 0
Annual Time Burden (Hours) 6,250 6,250 0 0 0 0
Annual Cost Burden (Dollars) 248,625 248,625 0 0 0 0
No
No

$137,480
No
    Yes
    Yes
No
No
No
No
Phil Ahn 202 501-2447

  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:
 
 
 
 
 
 
 
    (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.
08/01/2022


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