2018 SIPP Panel OMB Form 83-I

PAPERWORK REDUCTION ACT SUBMISSION
Please read the instructions before completing this form. For additional forms or assistance in completing this form, contact your
agency's Paperwork Clearance Officer. Send two copies of this form, the collection instrument to be reviewed, the Supporting
Statement, and any additional documentation to: Office of Information and Regulatory Affairs, Office of Management and Budget,
Docket Library, Room 10102, 725 17th Street NW, Washington, DC 20503.
2. OMB CONTROL NUMBER

1. AGENCY/SUBAGENCY ORIGINATING REQUEST

DOC/CENSUS/Associate Director for Demographic Programs-Survey
Operations

a.

XXXX

b. NONE

4. TYPE OF REVIEW REQUESTED (X one)

3. TYPE OF INFORMATION COLLECTION (X one)

X

X

0607

a. NEW COLLECTION

a. REGULAR SUBMISSION
b. EMERGENCY - APPROVAL REQUESTED BY:

b. REVISION OF A CURRENTLY APPROVED COLLECTION

c. DELEGATED

c. EXTENSION OF A CURRENTLY APPROVED COLLECTION
d. REINSTATEMENT, WITHOUT CHANGE, OF A PREVIOUSLY
APPROVED COLLECTION FOR WHICH APPROVAL HAS EXPIRED

5. SMALL ENTITIES
Will this information collection have a significant economic
impact on a substantial number of small entities?

e. REINSTATEMENT, WITH CHANGE, OF A PREVIOUSLY
APPROVED COLLECTION FOR WHICH APPROVAL HAS EXPIRED

YES
X NO
6. REQUESTED EXPIRATION DATE

X

f. EXISTING COLLECTION IN USE WITHOUT AN OMB CONTROL
NUMBER

a. THREE YEARS FROM APPROVAL DATE
b. OTHER:

7. TITLE

2018 Survey of Income and Program Participation (SIPP) Panel
8. AGENCY FORM NUMBER(S) (if applicable)
SIPP-105(L1)2018 - Director's Letter w/o incentive, SIPP-105(L3)2018 - Director's Letter w/incentive, SIPP-105(L)(SP)2018 - Director's Letter Spanish, SIPP/CAPI
Automated Instrument, SIPP-101 (Factsheet), SIPP-106(L1)2018 - Thank you Letter w/o incentive, SIPP-106(L2)2018 - Thank you Letter w/ incentive/PIN
Information
9. KEYWORDS
Income Distribution, Program Participation

10. ABSTRACT
This survey will provide improved statistics for the executive and legislative branches on income distribution and data not previously available on eligibility for and
participation in government programs. Changes in status and participation will be measured over time. These data will support policy and program planning. All
people 15 years old or older in sample households are interviewed.

11. AFFECTED PUBLIC (Mark primary with "P" and all others that apply with "X")
P

a. INDIVIDUALS OR HOUSEHOLDS

P

e. FEDERAL GOVERNMENT

c. NOT-FOR-PROFIT INSTITUTIONS

f. STATE, LOCAL OR TRIBAL GOVERNMENT

a. NUMBER OF RESPONDENTS
b. TOTAL ANNUAL RESPONSES
(1) Percentage of these responses collected electronically
c. TOTAL ANNUAL HOURS REQUESTED
d. CURRENT OMB INVENTORY
e. DIFFERENCE (+, -)
EXPLANATION OF
DIFFERENCE:

(1) Program change (+, -)

66,800
66,800
100
66,800
0
66,800
66,800

a. TOTAL CAPITAL/STARTUP COSTS
c. TOTAL ANNUALIZED COST REQUESTED
d. CURRENT OMB INVENTORY
e. DIFFERENCE (+, -)
f.

d. AUDIT

17. STATISTICAL METHODS
Does this information collection employ
statistical methods?
X

YES

OMB FORM 83-I, 10/95

NO

EXPLANATION OF DIFFERENCE:
(1) Program change (+, -)

16. FREQUENCY OF RECORDKEEPING OR REPORTING (X all that apply)
a. RECORDKEEPING

e. PROGRAM PLANNING
OR MANAGEMENT

c. GENERAL PURPOSE STATISTICS

0.00

b. TOTAL ANNUAL COSTS (O&M)

"P" and all others that apply with "X")
b. PROGRAM EVALUATION

c. MANDATORY

(2) Adustment (+, -)

15. PURPOSE OF INFORMATION COLLECTION (Mark primary with

P

others that apply with "X")

14. ANNUALIZED COST TO RESPONDENTS (In thousands of dollars)

(2) Adustment (+, -)

a. APPLICATION FOR BENEFITS

a. VOLUNTARY

b. REQUIRED TO OBTAIN OR RETAIN BENEFITS

b. BUSINESS OR OTHER FOR-PROFIT

13. ANNUAL REPORTING AND RECORDKEEPING HOUR BURDEN

f.

12. OBLIGATION TO RESPOND (Mark primary with "P" and all

d. FARMS

f. RESEARCH
g. REGULATORY OR
COMPLIANCE

X

b. THIRD PARTY DISCLOSURE

c. REPORTING:
(1) On Occasion

(2) Weekly

(4) Quarterly

(5) Semi-Annually

(7) Biennially

(8) Other (Describe)

(3) Monthly

X

(6) Annually

18. AGENCY CONTACT (Person who can best answer questions regarding the content of this
submission)
a. NAME

Jason Fields

b. TELEPHONE NUMBER (Include area code)

(301) 763-2465

OMB CONTROL NUMBER

0607

XXXX

TITLE

2018 Survey of Income and Program Participation (SIPP) Panel

19. CERTIFICATION FOR PAPERWORK REDUCTION ACT SUBMISSIONS
a. PROGRAM OFFICIAL CERTIFICATION (Internal DOC Use Only)
Type name

Date

Enrique Lamas, Performing the Non-Exclusive Functions and Duties of the Deputy Director

On behalf of this Federal agency, I certify that the collection of information encompassed by this request
complies with 5 CFR 1320.9.
NOTE: The text of 5 CFR 1320.9, and the related provisions of 5 CFR 1320.8(b)(3), appear at the end of the
instructions. The certification is to be made with reference to those regulatory provisions as set forth in the
instructions.
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 (see note in Item 19 of the instructions);
(i) If applicable, it uses effective and efficient statistical survey methodology; and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item below and explain the
reason in Item 18 of the Supporting Statement.

b. SENIOR OFFICIAL OR DESIGNEE CERTIFICATION
Type name

Jennifer Jessup, Departmental Paperwork Clearance Officer
OMB FORM 83-I (BACK), 10/95

Date