Applicant Background Survey

ICR 200908-0990-005

OMB: 0990-0208

Federal Form Document

Forms and Documents
Document
Name
Status
Supporting Statement A
2009-08-07
IC Document Collections
IC ID
Document
Title
Status
10324 Modified
ICR Details
0990-0208 200908-0990-005
Historical Active 200603-0990-001
HHS/HHSDM
Applicant Background Survey
Extension without change of a currently approved collection   No
Regular
Approved with change 12/01/2009
Retrieve Notice of Action (NOA) 08/25/2009
Per agreement with EEOC, HHS will remove the disability questions from this collection pending additional interagency work to improve the targeted disabilities categories. To update the public record to reflect this agreement, HHS will submit the revised version to OMB through a change request.
  Inventory as of this Action Requested Previously Approved
12/31/2012 36 Months From Approved 11/30/2009
30,000 0 30,000
1,000 0 1,000
0 0 0

The results of this data collection will be used to assist the OPDIVs within HHS to determine if current recruitment sources yield qualified applicants from groups with low representation; and the effectiveness of current efforts to address barriers to representation in the workforce as required by the EEOC's MD-715.

US Code: 42 USC 2000e-16 Name of Law: Civil Rights Act 1964
   PL: Pub.L. 99 - 506 501 Name of Law: Rehabilitation Act 1973
  
None

Not associated with rulemaking

  74 FR 22553 05/13/2009
74 FR 41139 08/14/2009
Yes

1
IC Title Form No. Form Name
Applicant Background Survey

  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 30,000 30,000 0 0 0 0
Annual Time Burden (Hours) 1,000 1,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$40,000
No
No
Uncollected
Uncollected
No
Uncollected
Sherrette Funn-Coleman 2026905683

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
08/25/2009


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