Privacy Act Administration

Forms and Documents

Document Name	Status
Form DOE F 206.5 Public Citizens Form and Instruction	New
Form DOE F 206.5 Federal Government Employees Form and Instruction	Modified
1910-1700 -Supporting Statement A_Final 9.25.docx Supporting Statement A	2024-09-25
Privacy Act of 1974 - FinalPASORNCompilation.1.8.09.pdf Supplementary Document	2024-09-12
DOE Order 206.1A (approved 011924).pdf Supplementary Document	2024-09-12
30-day FRN 080124.pdf Supplementary Document	2024-09-12
60-day FRN 030124.pdf Supplementary Document	2024-09-12

IC Document Collections

IC ID	Document Title	Status
270766	Public Citizens Form and Instruction	New
137543	Federal Government Employees Form and Instruction	Modified

ICR Details

OMB Control No: 1910-1700	ICR Reference No: 202408-1910-002
Status: Received in OIRA	Previous ICR Reference No: 202101-1910-001
Agency/Subagency: DOE/DOEOA	Agency Tracking No: Brenda Canterbury
Title: Privacy Act Administration
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 09/25/2024

	Requested	Previously Approved
Expiration Date	36 Months From Approved	09/30/2024
Responses	390	406
Time Burden (Hours)	130	135
Cost Burden (Dollars)	11,199	17,766

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Abstract: The Privacy Act Information Request form assists the Dept. of Energy in processing PA requests submitted by an individual or an authorized representative wherein he or she is requesting records the gov't may maintain on them. The Dept’s use of this form continues to contribute to the Dept’s PA process, including, but not limited to, providing for faster processing of PA info. requests by asking individuals or their authorized representative the pertinent information needed for record retrieval.

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Authorizing Statute(s): US Code: 5 USC 552a Name of Law: Records Maintained on Individuals
  

Citations for New Statutory Requirements: None

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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:
	89 FR 15196	03/01/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 63427	08/05/2024
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Federal Government Employees	DOE F 206.5	Privacy Act Information Request
Public Citizens	DOE F 206.5	Privacy Act Information Request

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ICR Summary of Burden

	Total Request	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	390	406	0	0	-16	0
Annual Time Burden (Hours)	130	135	0	0	-5	0
Annual Cost Burden (Dollars)	11,199	17,766	0	0	-6,567	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: The change of burden from the previously approved submission is due to the decrease in the number of respondents, which has resulted in a reduction of annual burden hours. Additionally, the hourly rate for respondents has been updated to the 2023 basic hourly wage rate for a GS 14.

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Annual Cost to Federal Government: $41,675

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: 09/25/2024

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