Incoming and Outgoing Intergovernmental Personnel Act (IPA) Assignment Agreement

Forms and Documents

Document Name	Status
Form SSA-187 Non-Federal Employer Signers Form and Instruction	New
Form SSA-187 Non-Federal Employee Respondent Form and Instruction	New
Addendum - IPA.doc Supplementary Document	2011-12-30
Supporting Statement - IPA.doc Supporting Statement A	2012-01-03

IC Document Collections

IC ID	Document Title	Status
199024	Non-Federal Employer Signers Form and Instruction	New
199023	Non-Federal Employee Respondent Form and Instruction	New

ICR Details

OMB Control No: 0960-0792	ICR Reference No: 201108-0960-009
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: SSA	Agency Tracking No:
Title: Incoming and Outgoing Intergovernmental Personnel Act (IPA) Assignment Agreement
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/13/2012
	Date Received in OIRA: 01/13/2012
Terms of Clearance: SSA is asked to report this collection as a violation in next datacall for the information collection budget.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2015	36 Months From Approved
Responses	30	0	0
Time Burden (Hours)	7	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Intergovernmental Personnel Act (IPA) mobility program provides for the temporary assignment of personnel between the Federal Government and state and local governments, colleges and universities, Indian tribal governments, federally funded research and development centers, and other eligible organizations. Federal agencies are responsible for certifying the eligibility of "other organizations" for participation in the mobility program. The Office of Personnel Management created a generic form, the OF-69, for agencies to use when collecting information for the IPA assignment, including the name, social security number, job title, salary, classification, and address of the employee enrolled in the program, as well as information regarding the type of assignment, and how that assignment will benefit those agencies involved in the exchange. However, the OF-69 does not include all the information SSA requires for the IPA. Therefore, SSA created our own versions of the form, one for incoming employees and one for outgoing employees. Once approved, SSA will use our versions of the forms for the IPA agreements. Respondents are personnel from state and local governments, colleges and universities, Indian tribal governments, federally funded research and development centers, and other eligible organizations who participate in the IPA exchange.

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Authorizing Statute(s): US Code: 5 USC 3371 - 3375 Name of Law: Assignments to and from States
  

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:
	76 FR 59180	09/23/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 147	01/03/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Non-Federal Employee Respondent	SSA-187, SSA-188	Assignment Agreement Title IV of the Intergovernmental Personnel Act of 1970: Instructions for Incoming Assignments ,   Assignment Agreement Title IV of the Intergovernmental Personnel Act of 1970: Instructions for Outgoing Assignments
Non-Federal Employer Signers	SSA-188, SSA-187	Assignment Agreement Title IV of the Intergovernmental Personnel Act of 1970: Instructions for Incoming Assignments ,   Assignment Agreement Title IV of the Intergovernmental Personnel Act of 1970: Instructions for Outgoing Assignments

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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	30	0	0	30	0	0
Annual Time Burden (Hours)	7	0	0	7	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: These forms, in use without an OMB number, increase the public reporting burden. See the chart above for burden figures.

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Annual Cost to Federal Government: $202,000

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]? 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? 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: 01/13/2012

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