Claim for Relocation Payments - Residential, DI-381; Claim for Relocation Payments - Nonresidential, DI-382

Forms and Documents

Document Name	Status
Form DI-382 Claim for Relocation Payments - Nonresidential Form and Instruction	Modified
Form DI-381 Claim for Relocation Payments - Residential Form and Instruction	Modified
1084-0010 Nonsubstantive Change Request Explanation.docx Justification for No Material/Nonsubstantive Change	2019-03-05
1084-0010 SS_A-RelocationForms_8-14-2018.docx Supporting Statement A	2018-10-16
1084-0010 - 30 Day Notice - 83 FR 52230.pdf Supplementary Document	2018-10-16
1084-0010 - 60 Day Notice 83 FR 18342.pdf Supplementary Document	2018-08-30
42 U.S.C. 4622.pdf Supplementary Document	2009-02-13

IC Document Collections

IC ID	Document Title	Status
188067	Claim for Relocation Payments - Nonresidential Form and Instruction	Modified
11562	Claim for Relocation Payments - Residential Form and Instruction	Modified

ICR Details

OMB Control No: 1084-0010	ICR Reference No: 201903-1084-001
Status: Historical Active	Previous ICR Reference No: 201808-1084-001
Agency/Subagency: DOI/OAPM	Agency Tracking No:
Title: Claim for Relocation Payments - Residential, DI-381; Claim for Relocation Payments - Nonresidential, DI-382
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/25/2019
	Date Received in OIRA: 03/05/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2021	12/31/2021	12/31/2021
Responses	24	0	24
Time Burden (Hours)	20	0	20
Cost Burden (Dollars)	0	0	0

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Abstract: The information on the application will be used to determine the amount of money, if any, owed to persons or businesses displaced by Federal acquisition of their real property.

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Authorizing Statute(s): US Code: 42 USC 4601 Name of Law: Uniform Relocation Assistance and Real Propperty Acquisition Policies
  

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:
	83 FR 18342	04/26/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 52230	10/16/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Claim for Relocation Payments - Residential	DI-381	Claim for Relocation Payments - Residential
Claim for Relocation Payments - Nonresidential	DI-382	Claim for Relocation Payments - Nonresidential

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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	24	24	0	0	0	0
Annual Time Burden (Hours)	20	20	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: $2,692

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: 03/05/2019

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