NCUA Personnel Security Processing Forms

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1092 Personnel Security Data Form-Employee	Form and Instruction	Modified	Available
Form 1092 Personnel Security Data Form-Employee	Form and Instruction	Modified	Available
Form 1093 Authorization for Release of Credit Information	Form and Instruction	Modified	Available
Form 1093 Credit Release	Form and Instruction	Modified	Repair queued
Form 1092C Personnel Security Data Form-Contractor	Form and Instruction	Modified	Available
Form 1092C Personnel Security Data Form-Contractor	Form and Instruction	Modified	Repair queued
FINAL_3133-0201_SS_102022.docx	Supporting Statement A	Uploaded 2022-10-20	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
236447	Personnel Security Data Form-Employee	Form and Instruction	Modified	Personnel Security Data Form-Employee
236447	Personnel Security Data Form-Employee	Form and Instruction	Modified
236446	Credit Release	Form and Instruction	Modified	Authorization for Release of Credit Information
236446	Credit Release	Form and Instruction	Modified
236445	Personnel Security Data Form-Contractor	Form and Instruction	Modified	Personnel Security Data Form-Contractor
236445	Personnel Security Data Form-Contractor	Form and Instruction	Modified

ICR Details

OMB Control No: 3133-0201	ICR Reference No: 202210-3133-001
Status: Historical Active	Previous ICR Reference No: 201909-3133-001
Agency/Subagency: NCUA	Agency Tracking No: OCSM
Title: NCUA Personnel Security Processing Forms
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 without change	Conclusion Date: 11/22/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/20/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2025	36 Months From Approved	11/30/2022
Responses	1,200	0	1,200
Time Burden (Hours)	200	0	200
Cost Burden (Dollars)	0	0	0

---

Abstract: Title 5, Code of Federal Regulations, Part 731 (suitability), Executive Order (E.O.) 13764 (contractor fitness), E.O. 12968/SEAD 4 (classified access), and Homeland Security Directive-12 (badging) requires all federal and contractor employees to undergo a background investigation when seeking employment with an agency. The NCUA Personnel Security Processing Forms (Personnel Security Data Form-Contractor, Personnel Security Data Form-Employee and the Authorization for Release of Credit Information) are used to collect information necessary for applying the government-established suitability/fitness criteria on employees before they can begin employment with or perform contractual services for the NCUA. It may be also required should a contract employee be moved to a new contract work. The background investigation process culminates in an adjudicative determination on whether or not these employees are fit to perform services on behalf of the agency.

---

Authorizing Statute(s): EO: EO 12968 Name/Subject of EO: Classified Access
   EO: EO 13764 Name/Subject of EO: Contractor fitness
  

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 47233	08/02/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 61373	10/11/2022
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Credit Release	1093	Authorization for Release of Credit Information
Personnel Security Data Form-Contractor	1092C	Personnel Security Data Form-Contractor
Personnel Security Data Form-Employee	1092	Personnel Security Data Form-Employee

---

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	1,200	1,200	0	0	0	0
Annual Time Burden (Hours)	200	200	0	0	0	0
Annual Cost Burden (Dollars)	0	0	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:

---

Annual Cost to Federal Government: $434,825

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: 10/20/2022

---