FNS 775 EmpowHR/Person Model Non-Employee Data Sheet

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form FNA-775 EmpowHR/Person Model Non-Employee Data Sheet	Form and Instruction	Modified	Available
Form FNA 775 EmpowHR/Person Model Non-Data Employee Sheet	Form	Modified	Available
Appendix F Burden Table.xlsx	Supplementary Document	Uploaded 2026-08-25	Available
Appendix D.pdf	Supplementary Document	Uploaded 2026-08-25	Available
Appendix C.pdf	Supplementary Document	Uploaded 2026-08-25	Available
Appendix A Legal Authority.pdf	Supplementary Document	Uploaded 2026-08-25	Available
Supporting Statement FNS 775 Updated 082526.docx	Supporting Statement A	Uploaded 2026-08-25	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
260090	Business (Contractors)	Other-Appendix E EmpowHr Screenshots (2)	Modified
260090	Business (Contractors)	Form and Instruction	Modified	EmpowHR/Person Model Non-Employee Data Sheet
259304	Individuals/Households	Other-Appendix E EmpowHr Screenshots	Modified
259304	Individuals/Households	Form	Modified	EmpowHR/Person Model Non-Data Employee Sheet

ICR Details

OMB Control No: 0584-0686	ICR Reference No: 202605-0584-001
Status: Received in OIRA	Previous ICR Reference No: 202303-0584-002
Agency/Subagency: USDA/FNS	Agency Tracking No:
Title: FNS 775 EmpowHR/Person Model Non-Employee Data Sheet
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 08/28/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	08/31/2026
Responses	750	750
Time Burden (Hours)	375	375
Cost Burden (Dollars)	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:
	91 FR 35951	06/16/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 55319	08/27/2026
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)	FNA-775	EmpowHR/Person Model Non-Employee Data Sheet
Individuals/Households	FNA 775	EmpowHR/Person Model Non-Data Employee Sheet

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ICR Summary of Burden

table that charts list 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	750	750	0	0	0	0
Annual Time Burden (Hours)	375	375	0	0	0	0
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: $2,197,308

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: 08/28/2026

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