FNS 775 EmpowHR/Person Model Non-Employee Data Sheet

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form FNS 775 EmpowHR Person Model	Form	New	Available
Form FNS 775 Individuals/Households	Form	New	Repair queued
Appendix F BPA 12314420A0034.pdf	Supplementary Document	Uploaded 2023-05-24	Repair queued
Appendix G Burden Table.xlsx	Supplementary Document	Uploaded 2023-05-22	Repair queued
Appendix D.pdf	Supplementary Document	Uploaded 2023-05-17	Repair queued
Appendix C.pdf	Supplementary Document	Uploaded 2023-05-17	Repair queued
Supporting Statement FNS 775_clean PRAO round 3 passback 6-5-2023_w-OCIO comments.docx	Supporting Statement A	Uploaded 2023-06-05	Repair queued
Appendix A Legal Authority.pdf	Supplementary Document	Uploaded 2023-05-08	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
260090	Business (Contractors)	Other-FNS 775 EmpowHR/Person Model sheet	New
259304	Individuals/Households	Form	New	EmpowHR Person Model
259304	Individuals/Households	Form	New
259304	Individuals/Households	Other-EmpowHR Person Model - 775 Screenshots	New

ICR Details

OMB Control No: 0584-0686	ICR Reference No: 202303-0584-002
Status: Active	Previous ICR Reference No:
Agency/Subagency: USDA/FNS	Agency Tracking No: PRA Violation FNS 775
Title: FNS 775 EmpowHR/Person Model Non-Employee Data Sheet
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/30/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/08/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2026	36 Months From Approved
Responses	750	0	0
Time Burden (Hours)	375	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The collection of the data such as full legal name, address, phone, social security number, birthdate, place of birth, country of citizenship is required to input into the USDA system of record, Empower Human Resources (EmpowHR), so that upon submission, it conforms to the data requirements set forth by USAccess. Please see Appendix B FNS 775 EmpowHR/Person Model which shows the required biographic data to be collected for system input. Legal authority for gathering of data fields mentioned above comes from the Homeland Security Presidential Directive 12 (Appendix A Legal Authority). The Directive references HSPD-12 as the chosen standard for data collection for employees and contractors. HSPD-12 was issued on August 12, 2004 and calls for a mandatory, government-wide standard for secure and reliable ID for all of its employees and contractors to access federally-controlled facilities and networks. Based upon this directive, the National Institute for Standards and Technology (NIST) developed Federal Information Processing Standards Publication (FIPS Pub) 201. USDA’s LincPass card is designed to link a person’s identity to an ID credential and the credential to a person’s ability to physically and logically access federally controlled buildings and information systems, respectively. Authorizing statute includes 731.106(c)(2).

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Authorizing Statute(s): None

Citations for New Statutory Requirements: PL: Pub.L. 104 - 193 346 Name of Law: Department of Agriculture Personal Responsibility and Work Opportunity Reconciliation Act of 1996

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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 37813	06/24/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 37506	06/08/2023
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Business (Contractors)
Individuals/Households	FNS 775	EmpowHR Person Model

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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	750	0	0	0	0	750
Annual Time Burden (Hours)	375	0	0	0	0	375
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:

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Annual Cost to Federal Government: $1,338,519

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

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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: 06/08/2023

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