VA Police Officer Pre-Employment Screening Checklist

ICR 201611-2900-013

OMB: 2900-0524

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Unchanged
Supplementary Document
2016-11-30
Supporting Statement A
2016-11-30
IC Document Collections
IC ID
Document
Title
Status
28712 Unchanged
ICR Details
2900-0524 201611-2900-013
Historical Active 201303-2900-004
VA 2900-0524
VA Police Officer Pre-Employment Screening Checklist
Reinstatement without change of a previously approved collection   No
Emergency 12/01/2016
Approved without change 02/01/2017
Retrieve Notice of Action (NOA) 11/30/2016
  Inventory as of this Action Requested Previously Approved
05/31/2017 4 Months From Approved
1,500 0 0
250 0 0
0 0 0

The form serves as a record of pre-employment screening to determine the qualification and suitability of the applicant.
The VA Form 0120, VA Police Officer Pre-employment Screening Checklist, involves thorough pre-employment screening and special background checks for police officer applicants. It also provided a record of pre-employment screening in conformance with selection standards that ensure that Federal criminal law enforcement authority is granted cautiously and responsibly

US Code: 38 USC 512 Name of Law: Delegation of authority; assignment of functins and duties
   US Code: 38 USC 3301 Name of Law: Civil service; generally
  
None

Not associated with rulemaking

  81 FR 86073 11/29/2016
No

1
IC Title Form No. Form Name
VA Police Officer Pre-Employment Screening Checklist VA Form 0120 VA Police Officer Pre-Employment Screening Checklist

  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 1,500 0 0 0 0 1,500
Annual Time Burden (Hours) 250 0 0 0 0 250
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$6,387
No
No
No
No
No
Uncollected
Cynthia Harvey - Pryor 202 461-5870 cynthia.harvey-pryor@va.gov

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
11/30/2016


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