Supporting Statement for VA Form Letter 5-127,
Inquiry concerning Applicant for Employment
(2900-0117)
A. Justification
1. VA Form Letter 5-127 is used by VA personnel officials to verify qualifications and determine suitability of applications for VA employment. This information is obtained from individuals who have knowledge of the applicant’s past work record, performance, and character. VA Handbook 5005, part II, chapter 2, section A, paragraph 5.d(3), requires verification of employment and suitability that necessitate the collection of this information
2. The information obtained through use of VA Form Letter 5-127 is used by appointing officials in determining an applicant’s suitability and qualifications for employment. If the information were not collected, the risk of appointing unqualified or unsuitable individuals would increase.
3. The use of automated collection techniques is not anticipated because responding to the collection of information is voluntary and VA needs to obtain the signature of the individual supplying the requested information.
4. There is no duplication associated with this collection of information.
5. The impact on small businesses and other small entitles are minimized by using “standard” or data routinely maintained by health care facilities. The collection of information has been thoroughly analyzed to ensure that all requested is essential.
6. If VA does not require this information, the risk of appointing unqualified or unsuitable individuals would increase.
7. There are no special circumstances requiring that the collection be conducted in any manner inconsistent with 5 CFR 1320.6 guidelines.
8. The agency notice was published in the Federal Register on April 25, 2013, Volume 78, Number 80 at pages 24468-24469. There were no comments received.
9. No payments or gifts to respondents have been made under this collection of information.
10. We comply with the provisions of Title 38, U.S. Code 3301 and the Privacy Act of 1974, Title 5, U.S. Code 552a. In addition, the respondents have the opportunity to choose whether they want their identities revealed to the applicant. If the respondent does not want to be identified, VA personnel officials are required to comply.
11. There are no questions of a sensitive nature.
12. Estimate of Information Collection Burden:
Number of respondents is estimated at 12,500 per year.
Frequency of response is one time
Average time is 15 minutes.
Annual burden is 3,125 hours.
Annual cost to respondents $46,875 (3,125 hours x $ 15 per hours)
13. This collection does not involve a recordkeeping cost burden to respondents.
14. Estimate of the Cost to the Federal government - $27,068
Mailing Cost $16,625
Collecting and Processing Costs $ 2,343
Analytical Cost $ 7,100
Printing and Distribution Cost $ 1,000
Total Cost $27,068
15. There is no change in burden.
16. The information collected is not for publication or statistical use.
17. Not applicable.
18. This submission does not contain any exceptions to the certification statement.
B. COLLECTION OF INFORMATION EMPLOYING STATISTICAL METHODS
Statistical methods are not appropriate in this instance.
| File Type | application/msword |
| File Title | Microsoft Word 6.0 Prototype |
| Author | SERGRIN |
| Last Modified By | Rennie, Crystal |
| File Modified | 2013-07-18 |
| File Created | 2013-07-18 |