Statement of Witness, Standard Form (SF) 94

Forms and Documents

Document Name	Status
Form SF-94 Statement of Witness, Standard Form (SF) 94 Form	Modified
3090-0118 Supporting Statement B.docx Supporting Statement B	2017-07-12
3090-0118 Supporting Statement A.doc Supporting Statement A	2017-07-12

IC Document Collections

IC ID	Document Title	Status
32404	Statement of Witness, Standard Form (SF) 94 Form	Modified

ICR Details

OMB Control No: 3090-0118	ICR Reference No: 201707-3090-001
Status: Historical Active	Previous ICR Reference No: 200501-3090-004
Agency/Subagency: GSA	Agency Tracking No:
Title: Statement of Witness, Standard Form (SF) 94
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/29/2017
	Date Received in OIRA: 07/12/2017
Terms of Clearance: GSA should consider if this form could be set up as a common form. In addition, when this form is re-submitted, GSA needs to include a Privacy Act statement as well as a privacy impact assessment and a systems of records notice if applicable.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2020	36 Months From Approved
Responses	874	0	0
Time Burden (Hours)	291	0	0
Cost Burden (Dollars)	159,907	0	0

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Abstract: Standard Form (SF)94 is necessary to provide the Federal Government data on motor vehicle accidents and traffic violations. The form is used by persons who have witnessed an accident.

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Authorizing Statute(s): None

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:
	82 FR 19722	04/28/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 31330	07/06/2017
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
Statement of Witness, Standard Form (SF) 94	SF-94	Statement of Witness

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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	874	0	0	0	0	874
Annual Time Burden (Hours)	291	0	0	0	0	291
Annual Cost Burden (Dollars)	159,907	0	0	159,907	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: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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: 07/12/2017

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