USDA PIV Request for Credential

Forms and Documents

Document Name	Status
Form AD-1197 USDA PIV Request for Credential Form	Modified
FAIR CREDIT REPORTING ACT OF 1970.pdf Supplementary Document	2017-02-13
OMB SuptStmt Questions 2016 0505-0022.doc Supporting Statement A	2017-02-13
of0306 0505-0022.pdf Supplementary Document	2017-02-13
HSPD-12 Directive_001.pdf Supplementary Document	2017-02-13
sf86 0505-0022.pdf Supplementary Document	2017-02-13
sf85p 0505-0022.pdf Supplementary Document	2017-02-13
sf85 NS 0505-0022.pdf Supplementary Document	2017-02-13

IC Document Collections

IC ID	Document Title	Status
985	USDA PIV Request for Credential Form	Modified

ICR Details

OMB Control No: 0505-0022	ICR Reference No: 201702-0505-001
Status: Historical Active	Previous ICR Reference No: 201308-0505-001
Agency/Subagency: USDA/OCFO	Agency Tracking No:
Title: USDA PIV Request for Credential
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: 04/11/2017
	Date Received in OIRA: 02/13/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2020	36 Months From Approved	04/30/2017
Responses	12,000	0	12,000
Time Burden (Hours)	30,000	0	30,000
Cost Burden (Dollars)	0	0	0

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Abstract: This form collects information related to USDA employees, contractors, and non-employee affiliates applying for a USDA credential (identification card), in accordance with Homeland Security Presidential Directive 12 and Federal Information Processing Standard 201.

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Authorizing Statute(s): PL: Pub.L. 110 - 53 523 Name of Law: The Implementing the 9/11 Recommendtions Act of 2007
  

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:
	81 FR 87903	12/06/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 10450	02/13/2017
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
USDA PIV Request for Credential	AD-1197	Request for USDA Identification (ID) Badge

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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	12,000	12,000	0	0	0	0
Annual Time Burden (Hours)	30,000	30,000	0	0	0	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: $157,320

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

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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: 02/13/2017

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