Final - Supporting Statement

SUPPORTING STATEMENT FOR
PAPERWORK REDUCTION ACT SUBMISSION

Government, Corporate or Foundation, and Individual Donor Form

Application

OMB Number 1405-0218
DS-4271, DS-4272, DS-4273

A. JUSTIFICATION

1. The Office of Emergencies in the Diplomatic and Consular Services (EDCS) manages the solicitation and acceptance of gifts to the U.S. Department of State. The information requested via donor forms is a necessary first step in accepting donations. The information sought is pursuant to 22 U.S.C 2697, 5 U.S.C. 7342 and 22 CFR, Part 3.

2. The information collected will be used by EDCS’s Gift Fund Coordinator to demonstrate the donor’s intention to donate either an in-kind or monetary gift to the Department. Collection of this information is mandatory and a form must be completed before the gift is received by the Department.

3. The donor forms are available upon request. A copy of the appropriate form will be submitted to the donor from the requesting Bureau. Donors can print the forms, fill them out, and mail them to EDCS. The Department intends to create an electronic submission option by the next collection renewal.

4. EDCS is the only office in the Department managing the donor program so no other office or program is requesting duplicate information from the public.

5. This collection of information will not have a significant impact on small businesses or other small entities. Small businesses may give in-kind or cash gifts to the Department. The Department estimates it will take a small business five minutes to complete a form, put it in an envelope, address it, and mail it to the Department. To further reduce burden, the Department has plans to develop a donor computer application on www.state.gov so forms can be submitted electronically.

6. Without the information collection, EDCS would not be able to accept gifts from donors to the Department. The information is collected only once per donation.

7. There are no special circumstances.

8. On July 6, 2017, EDCS published a notice in the Federal Register seeking public comments on this proposed collection. See 82 F.R. 31386. No public comments were received.

9. No gifts or payments will be made to respondents.

10. All information will be handled in accordance with the Privacy Act. The Department has made no promises of confidentiality to the respondents.

11. No questions of a sensitive nature are asked.

12. Within the last fiscal year, the Department received 4,333 cash donations and 18 in-kind donations. We estimate 4,333 donations annually with an estimated average time to fill out a donation form of 5 minutes, for an annual burden of 361 hours. The hour cost burden for this collection is estimated to be $12,057. This is based on the U.S. Department of Labor, Bureau of Labor Statistics website (www.bls.gov). The wage rate category for “all occupations” (for individual or household respondents, chosen because the respondent could be from any occupation) is estimated to be $33.40 per hour ($23.86 x 1.4 wage rate multiplier), therefore, the estimated cost to respondents “all occupations” is estimated to be $12,057 annually based on 361 annual burden hours (361 x $33.40).

13. There will be no capital or start-up costs necessary for respondents. The only additional operation cost would be postage for the respondents to return the form to the Department. The Department estimates that there will be 4,333 forms mailed at 49 cents each, for a total of $2,123.

14. The Department estimates that it takes 10 minutes to process each form – opening the envelope, recording the information in a database, and sending a thank-you note back to the donor. Assuming a GS-12 step 5 base salary of $42.22 per hour, the Department’s cost would be $20,193 per year. (4,333 multiplied by 10 minutes equals 722 hours. 722 multiplied by $42.22 = $30,482 per year.)

15. There was a slight increase in the burden hours associated with this collection, from 305 hours to 361, due to an increase of 56 donations since the last time this collection was approved.

16. The information gathered via this information collection will not be published.

17. EDCS will display the OMB expiration date on hard copy and electronic versions of the forms.

18. EDCS does not request an exception to the certification of the information collection.

B. COLLECTION OF INFORMATION EMPLOYING STATISTICAL METHODS

This information collection does not employ statistical methods.