Certification of Identity and Consent Form

Forms and Documents

Document Name	Status
Form 10-945 Certification of Identity and Consent Form and Instruction	Modified
Privacy Act Files – Interior, DOI-57.pdf Supplementary Document	2019-11-08
Electronic FOIA Tracking System and FOIA Case Files – Interior, DOI-71.pdf Supplementary Document	2019-11-08
Incident Management, Analysis and Reporting System.pdf Supplementary Document	2019-11-08
1024-0280 Identity and Consent SSA_11.4.2019.docx Supporting Statement A	2019-11-04
1024-0280 60 day FRN 10-4-2019 (published).pdf Supplementary Document	2019-11-04
54 USC 100101.pdf Supplementary Document	2019-11-06
Privacy Act of 1974 5 USC §552a.pdf Supplementary Document	2019-11-04
Freedom of Information Act 5 USC §552.pdf Supplementary Document	2019-11-04

IC Document Collections

IC ID	Document Title	Status
224051	Certification of Identity and Consent Form and Instruction	Modified

ICR Details

OMB Control No: 1024-0280	ICR Reference No: 201911-1024-001
Status: Active	Previous ICR Reference No: 201610-1024-001
Agency/Subagency: DOI/NPS	Agency Tracking No:
Title: Certification of Identity and Consent Form
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: 06/29/2020
	Date Received in OIRA: 01/09/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2023	36 Months From Approved	06/30/2020
Responses	2,000	0	2,000
Time Burden (Hours)	100	0	100
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of the collection is to enable the NPS to locate applicable records and to respond to requests made under the Freedom of Information Act and the Privacy Act of 1974. Information includes sufficient personally identifiable information and/or source documents as applicable. The detailed personal information, to include the date/place of birth, as well as the requestor’s Social Security Number, is needed to identify records unique to the requestor. Failure to provide the required information may result in the NPS being unable to take any action on the request.

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Authorizing Statute(s): US Code: 54 USC 100101 Name of Law: National Park Service Organic Act
   US Code: 5 USC 552 Name of Law: Freedom of Information Act
   US Code: 5 USC 552a Name of Law: Privacy Act
  

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 53172	10/04/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 1182	01/09/2020
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
Certification of Identity and Consent	10-945	Certification of Identity and Consent

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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	2,000	2,000	0	0	0	0
Annual Time Burden (Hours)	100	100	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: $475,143

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? No

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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: 01/09/2020

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