Generic SSA Template

Fill out this template using the OMB Approval Clearance Manual. Gray sections must be completed, words highlighted in green should be replaced with accurate information, and sections highlighted in yellow should be checked for accuracy (REPLACE IF NOT ACCURATE, this is just suggested language).

Title of Study

Formative Data Collections for DOL Research

1290 - XXXX

Supporting Statement

Part A

MONTH YEAR

A1. Necessity for the Data Collection

The Chief Evaluation Office (CEO) at the U.S. Department of Labor (DOL) seeks approval for...

This proposed information collection meets the following goals of DOL’s generic clearance for formative data collections (1290-XXXX):

• inform the development of DOL research

• maintain a research agenda that is rigorous and relevant

• ensure that research products are as current as possible

• inform the provision of technical assistance.

Study Background

Legal or Administrative Requirements that Necessitate the Collection

There are no legal or administrative requirements that necessitate the collection. CEO is undertaking the collection at the discretion of the agency.

A2. Purpose of Survey and Data Collection Procedures

Overview of Purpose and Approach

Research Questions

Study Design

Universe of Data Collection Efforts

A3. Improved Information Technology to Reduce Burden

A4. Efforts to Identify Duplication

A5. Involvement of Small Organizations

A6. Consequences of Less Frequent Data Collection

A7. Special Circumstances

There are no special circumstances for the proposed data collection efforts.

A8. Federal Register Notice and Consultation

No public comments are requested for this information collection.

Consultation with Experts Outside of the Study

A9. Incentives for Respondents

No incentives for respondents are proposed for this information collection.

A10. Privacy of Respondents

Information collected will be kept private to the extent permitted by law. Respondents will be informed of all planned uses of data, that their participation is voluntary, and that their information will be kept private to the extent permitted by law.

As specified in the contract, the Contractor shall protect respondent privacy to the extent permitted by law and will comply with all Federal and Departmental regulations for private information. [The Contractor has developed a Data Safety and Monitoring Plan that assesses all protections of respondents’ personally identifiable information.] The Contractor shall ensure that all of its employees, subcontractors (at all tiers), and employees of each subcontractor, who perform work under this contract/subcontract, are trained on data privacy issues and comply with the above requirements. [Include reference to any pledges evaluation staff must sign, as required by the contractor].

As specified in the evaluator’s contract, the Contractor shall use Federal Information Processing Standard compliant encryption (Security Requirements for Cryptographic Module, as amended) to protect all instances of sensitive information during storage and transmission. The Contractor shall securely generate and manage encryption keys to prevent unauthorized decryption of information, in accordance with the Federal Processing Standard.  The Contractor shall: ensure that this standard is incorporated into the Contractor’s property management/control system; establish a procedure to account for all laptop computers, desktop computers, and other mobile devices and portable media that store or process sensitive information. Any data stored electronically will be secured in accordance with the most current National Institute of Standards and Technology (NIST) requirements and other applicable Federal and Departmental regulations. In addition, the Contractor must submit a plan for minimizing to the extent possible the inclusion of sensitive information on paper records and for the protection of any paper records, field notes, or other documents that contain sensitive or personally identifiable information that ensures secure storage and limits on access.  

Information will not be maintained in a paper or electronic system from which data are actually or directly retrieved by an individuals’ personal identifier.

A11. Sensitive Questions

There are no sensitive questions in this data collection.

A12. Estimation of Information Collection Burden

Total Burden Requested Under this Information Collection

Instrument	Total Number of Respondents	Annual Number of Respondents1	Number of Responses Per Respondent	Average Burden Hours Per Response	Annual Burden Hours	Average Hourly Wage	Total Annual Cost
Estimated Annual Burden Total

Total Annual Cost

A13. Cost Burden to Respondents or Record Keepers

There are no additional costs to respondents.

A14. Estimate of Cost to the Federal Government

The total cost for the data collection activities under this current request will be $XXX,XXX.

A15. Change in Burden

This is for an individual information collection under the umbrella formative generic clearance for DOL research (1290-XXXX).

A16. Plan and Time Schedule for Information Collection, Tabulation and Publication

A17. Reasons Not to Display OMB Expiration Date

All instruments will display the expiration date for OMB approval.

A18. Exceptions to Certification for Paperwork Reduction Act Submissions

No exceptions are necessary for this information collection.

1 Annualized over the three year period of the umbrella generic

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