Information Collection Request

Personnel Vetting Questionnaire

ICR 202302-3206-005 · OMB 3206-0279 · Historical Active

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 3206-0279 can be found here:

Forms and Documents

Forms and supporting documents for this ICR
Document	Type	Status	Availability
Form OPM 5093 Personnel Vetting Questionnaire	Form and Instruction	New	Available
3206-XXXX 30 Day FRN.pdf	Supplementary Document	Uploaded 2023-02-28	Repair queued
3206-XXXX 60 Day FRN.pdf	Supplementary Document	Uploaded 2023-02-28	Repair queued
Personnel Vetting Form Statement A.docx	Supporting Statement A	Uploaded 2023-02-28	Available

IC Document Collections

Information collection document groups
IC ID	Collection	Type	Status	Form
258819	Personnel Vetting Questionnaire	Form and Instruction	New
258819	Personnel Vetting Questionnaire		New

ICR Details

OMB Control No: 3206-0279

ICR Reference No: 202302-3206-005

Status: Historical Active

Previous ICR Reference No:

Agency/Subagency: OPM

Agency Tracking No:

Title: Personnel Vetting Questionnaire

Type of Information Collection: New collection (Request for a new OMB Control Number)

Common Form ICR: Yes

Type of Review Request:

OIRA Conclusion Action: Approved with change

Conclusion Date: 11/15/2023

Date Received in OIRA: 02/28/2023

Terms of Clearance: This collection is approved based on the revised materials provided by the Agency.

table that charts list comparision
	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2026
Responses	4,000	0	0
Time Burden (Hours)	9,768	0	0
Cost Burden (Dollars)	214,978	0	0

Abstract:

Authorizing Statute(s): EO: EO 13764 Name/Subject of EO: Amending the Civil Service Rules, Executive Order 13488, and Executive Order 13467 to Modernize the

Citations for New Statutory Requirements: None

Associated Rulemaking Information

RIN:

Stage of Rulemaking:

Federal Register Citation:

Date:

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR?

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

table that charts list of burden
IC Title	Form No.	Form Name
Personnel Vetting Questionnaire	3206-NEW, 3206-NEW, 3206-NEW, 3206-NEW, 3206-NEW

ICR Summary of Burden

table that charts list of burden
	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	4,000	4,000
Annual Time Burden (Hours)	9,768	9,768
Annual Cost Burden (Dollars)	214,978	214,978

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: PERSONNEL VETTING QUESTIONNAIRE (Replacing SF86, SF 85P, SF 85P-S, SF 85) and becomes Common Form

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods?

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.

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.

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

Reginfo record details
Common Form ICR: Yes
OIRA authorizes any Agency to begin using a Common Form associated with this ICR automatically after 10 calendar days from the date the agency's RCF including the common form was received in OIRA.
Description/Changes for Common Form Usage:

Approved RCFs using this ICR