Human Reliability Program

Forms and Documents

Document Name	Status
Form DOE F 470.7 Human Reliability Program (HRP) Alcohol Testing Form Form and Instruction	Modified
Form DOE F 470.6 Refusal to Consent Form	Modified
Form DOE F 470.5 Authorization and Consent to Release Human Reliability (HRP) Records in Connection with HRP Form	Modified
Form DOE F 470.4 Acknowledgement and Agreement to Participate in the Human Reliability Program (HRP) Form	Modified
Form DOE F 470.3 Human Reliability Program Form	Modified
1910-5122 Supporting Statement Final.doc Supporting Statement A	2009-11-16
1910-5122 Burden Hours Report.xls Supplementary Document	2009-09-28
1910-5122 Description of Collection Forms.doc Supplementary Document	2009-09-28

IC Document Collections

IC ID	Document Title	Status
44899	Human Reliability Program (HRP) Alcohol Testing Form Form and Instruction	Modified
44898	Refusal to Consent Form	Modified
44895	Authorization and Consent to Release Human Reliability (HRP) Records in Connection with HRP Form	Modified
44890	Acknowledgement and Agreement to Participate in the Human Reliability Program (HRP) Form	Modified
23449	Human Reliability Program Form	Modified

ICR Details

OMB Control No: 1910-5122	ICR Reference No: 200909-1910-002
Status: Historical Active	Previous ICR Reference No: 200611-1910-003
Agency/Subagency: DOE/DOEOA	Agency Tracking No: Felecia Briggs
Title: Human Reliability Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/18/2010
	Date Received in OIRA: 01/26/2010
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is approved for 3 years. Upon resubmission, it is suggested the agency continue to reassess burden estimates and review prior estimates for errors in calculation.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2013	36 Months From Approved	03/31/2010
Responses	51,700	0	57,500
Time Burden (Hours)	31,020	0	5,750
Cost Burden (Dollars)	0	0	0

---

Abstract: These Collections are used by DOE management to certify DOE that respondents were advised of the requirements for occupying or continuing to occupy a Human Reliability Program position.

---

Authorizing Statute(s): US Code: 42 USC 7254 Name of Law: The Public Health and Welfare
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1992-AA29	Final or interim final rulemaking	69 FR 15	01/23/2006

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 200	10/19/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 16	01/26/2010
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
Authorization and Consent to Release Human Reliability (HRP) Records in Connection with HRP	DOE F 470.5	Authorization and Consent to Release Human Reliability Program (HRP) Records in Connection with HRP
Refusal to Consent	DOE F 470.6	Refusal of Consent
Human Reliability Program (HRP) Alcohol Testing Form	DOE F 470.7	Human Reliability Program (HRP) Alcohol Testing Form
Acknowledgement and Agreement to Participate in the Human Reliability Program (HRP)	DOE F 470.4	Acknowledgment and Agreement to Participate in the Human Reliability Program (HRP)
Human Reliability Program	DOE F 470.3	Human Reliability Program (HRP) Certification

---

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	51,700	57,500	0	0	-5,800	0
Annual Time Burden (Hours)	31,020	5,750	0	0	25,270	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:

---

Annual Cost to Federal Government: $0

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

---

Common Form ICR:  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:

(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: 01/26/2010

---