Living Quarters Eligibility Questionnaire; GSA Form 5039

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form GSA 5039 LIVING QUARTERS ELIGIBILITY QUESTIONNAIRE	Form and Instruction	Modified	Available
Public comments_3090-0331.pdf	Public Comments	Uploaded 2026-10-22	Available
3090-0331 GSA Form 5039 Supporting Statement_10.22.26.docx	Supporting Statement A	Uploaded 2026-10-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
262266	Living Quarters Eligibility Questionnaire; GSA Form 5039	Form and Instruction	Modified	LIVING QUARTERS ELIGIBILITY QUESTIONNAIRE

ICR Details

OMB Control No: 3090-0331	ICR Reference No: 202610-3090-001
Status: Received in OIRA	Previous ICR Reference No: 202309-3090-001
Agency/Subagency: GSA	Agency Tracking No:
Title: Living Quarters Eligibility Questionnaire; GSA Form 5039
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/22/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	10/31/2026
Responses	25	25
Time Burden (Hours)	50	25
Cost Burden (Dollars)	0	0

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Abstract: 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 as well as an existing transportation agreement with another agency (if transferring to GSA). 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.

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Authorizing Statute(s): None

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:
	91 FR 9852	02/27/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 66706	10/22/2026
Did the Agency receive public comments on this ICR? Yes

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

table that charts list of burden

IC Title	Form No.	Form Name
Living Quarters Eligibility Questionnaire; GSA Form 5039	GSA 5039	LIVING QUARTERS ELIGIBILITY QUESTIONNAIRE

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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	25	25	0	0	0	0
Annual Time Burden (Hours)	50	25	0	25	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There are three changes: (a) the addition of a definitions section, (b) the addition of a new section discussing State Department regulations in lay-person language, and (c) an increase to the time burden for respondents completing the form. All three changes were due to suggestions from public commenters who we believe have been former respondents of the form and the allowance approval process. They suggested additional information would be a way to provide advice on the form itself, in terms of what information is collected and why it is collected by the agency. The Paperwork Reduction Act burden was also increased because the public commenters said that it takes time to collect attachments that often must be submitted along with the form, or documents that are needed to fill out certain sections of the form.

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Annual Cost to Federal Government: $875

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: 10/22/2026

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