Gilman Evaluation Survey

Forms and Documents

Document Name	Status
Form SV-2012-0008 Gilman Evaluation Survey Form and Instruction	New
Legal Authorities (7-2013).doc Supplementary Document	2013-07-03
Gilman Supporting Statement Part B (7-2013).docx Supporting Statement B	2013-07-03
Gilman Supporting Statement Final (7-2013).docx Supporting Statement A	2013-07-03

IC Document Collections

IC ID	Document Title	Status
207631	Gilman Evaluation Survey Form and Instruction	New

ICR Details

OMB Control No: 1405-0212	ICR Reference No: 201307-1405-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Gilman Evaluation Survey
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 with change	Conclusion Date: 07/11/2013
	Date Received in OIRA: 07/03/2013
Terms of Clearance: State Department will report to OMB on the results of the survey and response rates once completed.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2016	12 Months From Approved
Responses	2,474	0	0
Time Burden (Hours)	1,031	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This descriptive evaluation will investigate the outcomes of study abroad on recipients of the Benjamin A. Gilman International Scholarship. The Gilman Scholarship offers grants for U.S. citizen undergraduate students of limited financial means to pursue academic study abroad. This survey will review the experiences of grant recipients while abroad; probe ways in which they shared what they learned with family, peers, and other community members upon returning to the United States; and investigate whether the international experience factored into their subsequent educational and professional choices. This information collection will be conducted once, and will be comprised of one survey sent to all grant recipients who studied abroad during the nine-year period spanning the 2002/2003 and 2010/2011 academic years.

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Authorizing Statute(s): US Code: 22 USC 2451 Name of Law: Mutual Educational and Cultural Exchange Act of 1961
  

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 75251	12/19/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 15801	03/12/2013
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
Gilman Evaluation Survey	SV-2012-0008	Gilman Evaluation 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	2,474	0	0	2,474	0	0
Annual Time Burden (Hours)	1,031	0	0	1,031	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 is due to submission as a new collection

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Annual Cost to Federal Government: $192,033

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: 07/03/2013

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