Application for Employment as a Locally Employed Staff or Family Member

Forms and Documents

Document Name	Status
Form DS-0174 Application for Employment as a Locally Employed Staff or Family Member Form and Instruction	New
Overseas Employment Application-Supporting Statement.doc Supporting Statement A	2009-09-22
Overseas Employment Application-Legal Authorities.doc Supplementary Document	2009-09-22

IC Document Collections

IC ID	Document Title	Status
190750	Application for Employment as a Locally Employed Staff or Family Member Form and Instruction	New

ICR Details

OMB Control No: 1405-0189	ICR Reference No: 200909-1405-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Application for Employment as a Locally Employed Staff or Family Member
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/04/2009
	Date Received in OIRA: 09/22/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2012	36 Months From Approved
Responses	40,000	0	0
Time Burden (Hours)	40,000	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The DS-0174 is an employment application form designed specifically for positions recruited by the approximately 170 Department of State Missions abroad that meets the unique requirements of Mission recruitment. Candidates seeking employment include family members of Foreign Service, Civil Service, and Uniformed Service members officially assigned to the Mission and under Chief of Mission authority.

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Authorizing Statute(s): PL: Pub.L. 96 - 465 103,105.206,301,303,311,408 Name of Law: Foreign Service Act of 1980
   US Code: 22 USC 2669(c) Name of Law: Foreign Relations and Intercourse
  

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:
	74 FR 60	03/31/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 180	09/18/2009
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Application for Employment as a Locally Employed Staff or Family Member	DS-0174	Application for Employment as a Locally Employed Staff or Family Member

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ICR Summary of Burden

	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	40,000	0	0	40,000	0	0
Annual Time Burden (Hours)	40,000	0	0	40,000	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: Burden change due to collection submission under category of "New Collection".

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Annual Cost to Federal Government: $889,600

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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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: 09/22/2009

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