Partnerships with Faith-Based and Other Neighborhood Organizations

Forms and Documents

Document Name	Status
Form XXXX Partnerships with Faith-Based and Other Neighborhood Organizations Form and Instruction	New
1121-NEW_ ICR SS for NPRM - Part 38_081815.doc Supporting Statement A	2015-08-18

IC Document Collections

IC ID	Document Title	Status
217481	Partnerships with Faith-Based and Other Neighborhood Organizations Form and Instruction	New

ICR Details

OMB Control No: 1121-0353	ICR Reference No: 201507-1121-002
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: DOJ/OJP	Agency Tracking No:
Title: Partnerships with Faith-Based and Other Neighborhood Organizations
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: Comment filed on proposed rule	Conclusion Date: 10/19/2015
	Date Received in OIRA: 08/18/2015
Terms of Clearance: OMB files this comment in accordance with 5 CFR 1320.11( c ). This OMB action is not an approval to conduct or sponsor an information collection under the Paperwork Reduction Act of 1995. This action has no effect on any current approvals. If OMB has assigned this ICR a new OMB Control Number, the OMB Control Number will not appear in the active inventory. For future submissions of this information collection, reference the OMB Control Number provided. DOJ will address all public comments received in ICR from the NPRM.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The Agency is collecting this information, pursuant to Executive Order 13559, for the purpose of ensuring that faith-based or religious organizations, administering a program supported by direct and indirect Federal financial assistance, give written notice to beneficiaries and prospective beneficiaries or their right to be referred to an alternate provider. The respondents are faith-based or religious organizations.

---

Authorizing Statute(s): EO: EO 13559 Name/Subject of EO: Fundamental Principles and Policymaking Criteria for Partnerships with Faith-Based and Other Neighbo
  

Citations for New Statutory Requirements: EO: EO 13559 Name/Subject of EO: Fundamental Principles and Policymaking Criteria for Partnerships with Faith-Based and Other Neighbo

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1105-AB45	Proposed rulemaking	80 FR 1234	11/13/2014

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 48914	08/14/2015
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Partnerships with Faith-Based and Other Neighborhood Organizations	XXXX	Beneficiary Referral Request

---

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: New Collection

---

Annual Cost to Federal Government:

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

---

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: 08/18/2015

---