Certification of Identity

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DOJ-361 Certification of Identity	Form	Unchanged	Available
Form DOJ-361 Certification of Identity	Form	Unchanged	Repair queued
1103-0016 Supporting Statement A (2023) + OIP.docx	Supporting Statement A	Uploaded 2024-01-17	Repair queued
Electronic Code of Federal Regulations Title 28 Judicial Adminstration.pdf	Supplementary Document	Uploaded 2007-07-26	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
11586	Certification of Identity	Form	Unchanged	Certification of Identity
11586	Certification of Identity	Form	Unchanged

ICR Details

OMB Control No: 1103-0016	ICR Reference No: 202401-1103-002
Status: Active	Previous ICR Reference No: 202306-1103-005
Agency/Subagency: DOJ/DOJADM	Agency Tracking No: 1103-0016
Title: Certification of Identity
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/11/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/17/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2027	36 Months From Approved
Responses	69,000	0	0
Time Burden (Hours)	34,500	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: This form is used to identity individuals requesting records on self or another individual under the Privacy Act, 5 U.S.C. Section 552a(i)(3) and in accordance with the provisions of 28 C.F.R., Section 16.41(d).

---

Authorizing Statute(s): US Code: 5 USC 552 Name of Law: Public information; agency rules, opinions, orders, records, and proceedings
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1105-AB66	Final or interim final rulemaking	89 FR 1447	01/10/2024

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Certification of Identity	DOJ-361	Certification of Identity

---

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	69,000	0	0	0	0	69,000
Annual Time Burden (Hours)	34,500	0	0	0	0	34,500
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: $0

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: 01/17/2024

---