Applicant Background Survey

Forms and Documents

Document Name	Status
Form DI 1935 Applicant Background Survey Form and Instruction	Modified
30-day FR notice.pdf Supplementary Document	2012-07-17
1091-0001 Supporting Statement PART B 6-27-12.doc Supporting Statement B	2012-06-28
Statement of Paperwork Part A for DI1935 form 7-2-12.doc Supporting Statement A	2012-07-02
1091-0001 - 60 Day-77 FR 21992 - 4-12-12.pdf Supplementary Document	2012-06-25
29 CFR 1602.htm Supplementary Document	2009-04-01
US CODE Title 42,2000e�4_ Equal Employment Opportunity Commission.htm Supplementary Document	2009-04-01
5 USC 7201.txt Supplementary Document	2009-04-01

IC Document Collections

IC ID	Document Title	Status
11577	Applicant Background Survey Form and Instruction	Modified

ICR Details

OMB Control No: 1091-0001	ICR Reference No: 201204-1091-001
Status: Historical Active	Previous ICR Reference No: 200903-1091-001
Agency/Subagency: DOI/OEO	Agency Tracking No:
Title: Applicant Background Survey
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/07/2012
	Date Received in OIRA: 07/17/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2015	36 Months From Approved	09/30/2012
Responses	366,680	0	335,820
Time Burden (Hours)	6,111	0	11,194
Cost Burden (Dollars)	0	0	0

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Abstract: The collection of personal background data on job applicants is for purposes of planning and assessing affirmative employment program initiatives. Under these procedures, applicants and selectees are requested to provide, on a purely voluntary basis, information on their race, ethnic origin, gender, and disability to help ensure Department personnel practices meet the requirements of Federal law.

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Authorizing Statute(s): US Code: 5 USC Chapter 72, Section 7201 Name of Law: Antidiscrimination Policy
   US Code: 42 USC 2000e Name of Law: Civil Rights Act
  

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:
	77 FR 21992	04/12/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 41999	07/17/2012
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
Applicant Background Survey	DI 1935	Applicant Background Survey

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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	366,680	335,820	0	0	30,860	0
Annual Time Burden (Hours)	6,111	11,194	0	0	-5,083	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:

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Annual Cost to Federal Government: $66,501

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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: 07/17/2012

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