Personal Information Questionnaire

Forms and Documents

Document Name	Status
Form 10064 Personal Information Questionnaire Form and Instruction	Modified
0703-0012_DraftPIA_4.29.19.pdf Supplementary Document	2019-05-09
0703-0012_SS-A_05.9.19.docx Supporting Statement A	2019-05-09

IC Document Collections

IC ID	Document Title	Status
5207	Personal Information Questionnaire Form and Instruction	Modified

ICR Details

OMB Control No: 0703-0012	ICR Reference No: 201905-0703-002
Status: Active	Previous ICR Reference No: 201612-0703-002
Agency/Subagency: DOD/NAVY	Agency Tracking No: 0703-0012
Title: Personal Information Questionnaire
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: 06/10/2019
	Date Received in OIRA: 05/09/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2022	36 Months From Approved	06/30/2019
Responses	3,500	0	3,500
Time Burden (Hours)	875	0	875
Cost Burden (Dollars)	14,210	0	14,210

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Abstract: The information collected through NAVMC Form 10064, “Personal Information Questionnaire” is needed to verify a potential officer candidate’s moral character. Information pertaining to an applicant’s moral character is of the utmost importance when applying for a program. As a commissioned officer in the United States Marine Corps, these men and women will be expected to lead others by example, upholding the Marine Corps Values of honor, courage, and commitment. They will have Marines under their charge, and will be expected to be of the finest moral character.

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Authorizing Statute(s): US Code: 10 USC 12209 Name of Law: Officer Candidates
  

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:
	84 FR 3766	02/13/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 20346	05/09/2019
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
Personal Information Questionnaire	10064	Personal Information Questionnaire

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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	3,500	3,500	0	0	0	0
Annual Time Burden (Hours)	875	875	0	0	0	0
Annual Cost Burden (Dollars)	14,210	14,210	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: $15,134

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: 05/09/2019

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