Impact Assessment Questionnaire

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DFC-007a Impact Assessment Questionnaire: COVID-19 Response Version	Form and Instruction	Removed	Available
Form DFC-007a Impact Assessment Questionnaire: COVID-19 Response Version	Form and Instruction	Removed	Repair queued
Form DFC-007 DFC-007 with tracked changes	Form and Instruction	Modified	Available
Form DFC-007 Impact Assessment Questionnaire	Form and Instruction	Modified	Available
Form DFC-007 Impact Assessment Questionnaire	Form and Instruction	Modified	Repair queued
221104 DFC-007 SSB.docx	Supporting Statement B	Uploaded 2022-11-16	Repair queued
DFC-007 83-I Questionnaire for OMB.pdf	Supplementary Document	Uploaded 2022-11-16	Repair queued
221104 DFC-007 Supporting Statement.docx	Supporting Statement A	Uploaded 2022-11-16	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
241586	Impact Assessment Questionnaire: COVID-19 Response Version	Form and Instruction	Removed	Impact Assessment Questionnaire: COVID-19 Response Version
241586	Impact Assessment Questionnaire: COVID-19 Response Version	Form and Instruction	Removed
236742	Impact Assessment Questionnaire	Form and Instruction	Modified	DFC-007 with tracked changes
236742	Impact Assessment Questionnaire	Form and Instruction	Modified	Impact Assessment Questionnaire
236742	Impact Assessment Questionnaire	Form and Instruction	Modified

ICR Details

OMB Control No: 3015-0009	ICR Reference No: 202211-3015-001
Status: Historical Active	Previous ICR Reference No: 202202-3015-006
Agency/Subagency: DFC	Agency Tracking No: DFC‐007
Title: Impact Assessment Questionnaire
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/15/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/15/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2026	36 Months From Approved	02/29/2024
Responses	250	0	275
Time Burden (Hours)	375	0	695
Cost Burden (Dollars)	15,123	0	19,783

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Abstract: The DFC Impact Assessment Questionnaire is the principal document used by the agency’s application process to initiate the assessment of a potential project’s predicted 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:
	87 FR 52543	08/26/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 66166	11/02/2022
Did the Agency receive public comments on this ICR? No

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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
Impact Assessment Questionnaire	DFC-007, DFC-007	Impact Assessment Questionnaire ,   DFC-007 with tracked changes
Impact Assessment Questionnaire: COVID-19 Response Version	DFC-007a	Impact Assessment Questionnaire: COVID-19 Response Version

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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	250	275	0	-25	0	0
Annual Time Burden (Hours)	375	695	0	-320	0	0
Annual Cost Burden (Dollars)	15,123	19,783	0	-4,660	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: Yes

Burden Reduction Due to: Changing Forms

Short Statement: This simplified form will take a much shorter time to complete, resulting in a burden decrease.

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Annual Cost to Federal Government:

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: 12/15/2022

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