General Services Administration
Living Quarters Eligibility Questionnaire; GSA Form 5039
Justification – Part A Supporting Statement
Overview of Information Collection:
This information collection activity concerns an agency-specific form, GSA Form 5039, Living Quarters Allowance Eligibility Questionnaire. This form would be completed by job candidates who have been selected for appointment, reassignment, promotion, or transfer to civil service positions in foreign areas (i.e., outside the United States and its territories and possessions). The living quarters allowance is an authority which allows an agency to reimburse the cost of rent for private housing in an overseas area.
The purpose of the form is to collect information which is necessary to determine eligibility for this quarters allowance, under the terms of sections 031.12 and 130 of the State Department’s Standardized Regulations (DSSR).
The individuals completing this form will be either members of the public (i.e. not yet appointed to Federal service) or existing Federal employees already employed by GSA or currently appointed by a different agency within the Executive Branch of the U.S. Government.
This is the public comment period and information collection activity for use of this agency-specific GSA form.
Need & Method for the Information Collection. Explain the circumstances that make the collection of information necessary.
The information collected on this form will be used to determine eligibility for the living quarters allowance for foreign areas. The Department of State regulations for this authority require that the employee be recruited from the U.S., or, if already abroad, originally recruited from the U.S. and in continuous employment with the Federal Government overseas with a transportation agreement that establishes an employee’s entitlement to return relocation at the end of the foreign tour of duty. To satisfy this requirement, the job candidate must be able to demonstrate a continuous employment history with the U.S. government overseas.
The job candidate’s employment history will be collected, and the job applicant will sign the GSA Form 5039 certifying to the correctness of the information. The human resources staffing specialists within the Office of Human Resources, as well as the hiring manager, will oversee the collection and recording of the information. This will be a fillable form and once signed will be stored within the “Overseas Employment” folder within the Electronic Personnel Folder (eOPF). The form itself will be fillable (in Adobe Acrobat).
Use of the Information.
The information collected in the form will be used to accomplish several purposes. First, the information is used to determine eligibility for the living quarters allowance.
The information collected will also be used to complete the SF-50, Notification of Personnel Action, and the SF-52, Request for Personnel Action which are forms used as part of the recruitment action. These forms are input into personnel systems such as PeopleSoft ERP, which is used at GSA to manage employee and payroll records.
The GSA Form 5039 is considered an agency-only, or “temporary” form and is not provided to any other agency. Upon separation, the records in the electronic personnel file are not transmitted to the gaining agency (during agency transfer). Therefore, the GSA Form 5039 has an agency-specific purpose to document eligibility for the living quarters allowance.
Use of Information Technology.
The GSA Form 5039 will be filled out on paper or will be completed as a fillable form via Adobe Acrobat. The information recorded in the form represents data elements that are then entered into the printable fields of the SF-50, Notification of Personnel Action or the non-printing fields of that form or the unprinted data elements in the payroll processing system.
Non-duplication.
This GSA Form 5039 is unique because it collects together important information that is necessary for the accurate recording of personnel and payroll information related to foreign employment. The existing general form, SF-52, Request for Personnel Action, does not include most of the data fields needed for the purpose of identifying eligibility for the living quarters allowance.
Burden on Small Business. If the collection of information impacts small businesses or other small entities, describe any methods used to minimize burden. Did the agency consider any exemptions, alternate options, or partial or delayed compliance options for small businesses?
The GSA form 5039 will not be completed by small businesses. It will only be used by the very small number of job applicants each year who are selected to overseas positions at GSA (estimated at 25 or less annually).
Less Frequent Collection. Describe the consequence to Federal program or policy activities if the collection is not conducted or is conducted less frequently, as well as any technical or legal obstacles to reducing burden.
The data will only be collected one time per selected job applicant. If the data collection is not conducted, the likelihood of compensation and leave errors for individuals hired for overseas positions will remain at a high level (estimated at approximately 25%).
Paperwork Reduction Act Guidelines.
It is expected that if this form is used during the job candidate selection process that the candidate selected could be allowed up to 30 calendar days to work with the assigned human resources staffing specialist to complete and then sign a final and verified copy of the GSA Form 5039.
Consultation and Public Comments.
A 60-day notice published in the Federal Register at 88 FR 16447 on May 16, 2023. There were no public comments. A 30-day notice published in the Federal Register at 88 FR 64912 on September 20, 2023.
Gifts or Payment.
There is no gift or incentive that would be offered to complete the GSA Form 5039.
Privacy & Confidentiality.
This GSA Form 5040 is used to collect demographics and employment history information. The information will be handled in a manner similar to other personnel and payroll information, in the context of “personally identifiable information” (PII) as protected by the Privacy Act of 1974. The information will be keyed into personnel and payroll data systems, for secure storage, and the form itself will be scanned and stored into the official Electronic Personnel File, a system that is owned and operated by the Office of Personnel Management.
Records are covered by OPM's governmentwide System of Records Notice (SORN) OPM/GOVT-1 General Personnel Records (80 FR 74815; November 30, 2015), posted at https://www.opm.gov/information-management/privacy-policy/sorn/opm-sorn-govt-1-general-personnel-records.pdf. The Privacy Impact Assessment (PIA) for the Electronic Official Personnel Folder is posted at https://www.opm.gov/information-management/privacy-policy/privacy-policy/eopf-pia.pdf.
Sensitive Questions.
None of the questions are of a sensitive nature – the questions relate to the job candidate’s employment history, particularly if already overseas. There is no medical information contained in this form.
Burden per Response:
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Annual Burden:
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Estimated nonrecurring costs.
There are no non-recurring costs.
Estimated cost to the Government.
It is expected that the cost of the Government would be the hours needed to process the data collected on the form. If the processing of the data requires 30 minutes each, and there are 25 forms processed per year, and if the hourly rate is $70 per hour, then the total cost is $875 or less per year in staff time.
Reasons for changes. Explain the reasons for any program changes or adjustments reported on the burden worksheet.
This is a new information collection request.
Publicizing Results.
Results will not be published.
OMB Not to Display Approval.
Not applicable.
Exceptions to "Certification for Paperwork Reduction Submissions."
Not applicable
Surveys, Censuses, and Other Collections that Employ Statistical Methods.
Not Applicable
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Modified | 0000-00-00 |
| File Created | 2023-09-22 |