DFC-011 83-1 Questionnaire (signed)

OMB Information Collection Request (83-I information)

1. Is this a new form?

2. OMB Control Number:¹ Click here to enter text.

3. Agency Tracking Number: DFC-011

4. Form Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

5. Is this a “common form” that was developed in conjunction with other agencies? ²

6. Is this a “generic form” that is part of an earlier umbrella clearance?

7. Abstract. Please describe the needs and uses for the information collection in 4000 characters or less:³

This collection of information is necessary to enable the Agency to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficient, and satisfying experience with the Agency’s programs. This feedback will provide insights into customer or stakeholder perceptions, experiences and expectations, provide an early warning of issues with service, or focus attention on areas where communication, training or changes in operations might improve delivery of products or services. These collections will allow for ongoing, collaborative and actionable communications between the Agency and its customers and stakeholders. It will also allow feedback to contribute directly to the improvement of program management.

8. Type of Information Collection:

   1. ☒ New information collection

   2. ☐ Renewal of existing information collection with no changes

   3. ☐ Renewal of existing information collection with changes

   4. ☐ Reinstatement of expired information collection with no changes

   5. ☐ Reinstatement of expired information collection with changes

9. Type of Review Requested:

   1. ☒ Regular review

   2. ☐ Emergency review

10. Requested expiration date:

    1. ☒ Three years (maximum)

    2. ☐ Other time period: _____

11. Does the form contain surveys or censuses that employ statistical methods?⁴

12. Does the Supporting Statement serve as a joint Paperwork Reduction Act filing and a Privacy Impact Assessment?⁵

13. Is this form related to the Affordable Care Act?

14. Is this form related to the Dodd-Frank Act?

15. Is this form related to the American Recovery and Reinvestment Act of 2009 (ARRA)?

16. Authorizing Statutes:⁶

The Better Utilization of Investments Leading to Development Act of 2018 (the “BUILD Act”), Public Law 115-254.

17. Does this form propose the creation of a new agency regulation?

18. Citation & date for the publication of the 60 Day Notice (example: 69 FR 9783, July 31, 2014):⁷ 84 FR 32224, July 5, 2019

19. Citation & date for the publication of the 30 Day Notice (example: 71 FR 1438, October 1, 2014)⁸: 84 FR 84185. September 12, 2019

20. A. Total number of responses:⁹ 200

B. Time it takes an OPIC staff member to review one response (in hours): 0.2

C. The GS-14 step 1 hourly rate in the DC metro area:¹⁰ 56.15

The total cost to the government (A*B*C): $2,246.00

21. Obligation to Respond:

    1. ☐ Mandatory – criminal or civil penalties imposed for failure to respond

    2. ☐ Required to obtain or retain benefits – not mandatory, but respondents will be unable to obtain or retain a government benefit (like a loan or insurance coverage) if they do not complete the information collection. Most of OPIC’s forms fall into this category.

    3. ☒ Voluntary – purely voluntary, no negatives associated with a failure to respond. This most commonly refers to surveys.

22. If this collection is required or authorized by agency regulation rather than a statute, provide the CFR citation.¹¹ Click here to enter text.

23. Line of Business:

    1. International Affairs & Commerce - International Development

24. Privacy Act System of Records:

    1. ☒ Not applicable. The CISO informed me upon completion of a Privacy Threshold Analysis (PTA) that a Privacy Impact Assessment (PIA) was not necessary.

    2. ☐ Not applicable. The CISO performed a Privacy Impact Assessment (PIA), but informed me that this form would not be part of a system of records.

    3. ☐ Applicable. The CISO performed a Privacy Impact Assessment (PIA) and informed me that this form would be part of a system of records. A system of records notice (SORN) was published in the Federal Register. The name of the system is Click here to enter text. And the Federal Register citation for the notice is Click here to enter text.

25. Total Number of respondents per year:¹² 200

26. Will this information collection have a significant economic impact on a substantial number of small entities? If yes, number of respondents for small entities: Click here to enter text.

27. Affected public:

    1. ☐ Federal Government

    2. ☒ Individuals or households

    3. Private Sector

       1. ☒ Businesses or other for profits

       2. ☐ Farms

       3. ☒ Not-for-profit institutions

    4. ☐ State, Local and Tribal Governments

28. Percentage of respondents reporting electronically: 100%

29. Number of responses per respondent per year¹³: 1

30. Type of Collection and Burden on the public

	Time per response (hours)	Cost per response14
A. Reporting (filling out the form)15	0.5	37.50
B. Recordkeeping (new record maintenance costs incurred in order to answer questions on form) 16
C. Third party disclosure (public disclosures such as SEC filings or drug warning labels) 17
D. Total burden per response (sum lines A-C)	0.5	$37.50
E. Total number of respondents (question 25)	200	200
F. Number of responses per respondent (question 29)	1	1
Total annual burden (line D times line E times line F).	100	$7,50018

31. If the total annual burden is an increase or decrease in the previously claimed burden,¹⁹ please explain why in 4000 characters or less.

This is a new information collection.

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9.

The full text of 5 CFR 1320.9, and the related provisions of 5 CFR 1320.8(b)(3), appear at the end of this document. 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:

1. It is necessary for the proper performance of agency functions;

2. It avoids unnecessary duplication;

3. It reduces burden on small entities;

4. It uses plain, coherent, and unambiguous terminology that is understandable to respondents;

5. Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

6. It indicates the retention period for recordkeeping requirements;

7. It informs respondents of the information called for under 5 CFR 1320.8(b)(3):

   1. Why the information is being collected;

   2. Use of information;

   3. Nature of response (voluntary, required for a benefit, or mandatory);

   4. Nature and extent of confidentiality; and

   5. Need to display currently valid OMB control number;

8. 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);

9. It uses effective and efficient statistical survey methodology; and

10. 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.

____________________________ ____________________________ ___________________

Signature of Senior Official Title Date

§ 1320.9 Agency certifications for proposed collections of information.

As part of the agency submission to OMB of a proposed collection of information, the agency (through the head of the agency, the Senior Official, or their designee) shall certify (and provide a record supporting such certification) that the proposed collection of information—

(a) Is necessary for the proper performance of the functions of the agency, including that the information to be collected will have practical utility;

(b) Is not unnecessarily duplicative of information otherwise reasonably accessible to the agency;

(c) Reduces to the extent practicable and appropriate the burden on persons who shall provide information to or for the agency, including with respect to small entities, as defined in the Regulatory Flexibility Act (5 U.S.C. 601(6)), the use of such techniques as:

(1) Establishing differing compliance or reporting requirements or timetables that take into account the resources available to those who are to respond;

(2) The clarification, consolidation, or simplification of compliance and reporting requirements; or

(3) An exemption from coverage of the collection of information, or any part thereof;

(d) Is written using plain, coherent, and unambiguous terminology and is understandable to those who are to respond;

(e) Is to be implemented in ways consistent and compatible, to the maximum extent practicable, with the existing reporting and recordkeeping practices of those who are to respond;

(f) Indicates for each recordkeeping requirement the length of time persons are required to maintain the records specified;

(g) Informs potential respondents of the information called for under § 1320.8(b)(3);

(h) Has been developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected, including the processing of the information in a manner which shall enhance, where appropriate, the utility of the information to agencies and the public;

(i) Uses effective and efficient statistical survey methodology appropriate to the purpose for which the information is to be collected; and

(j) To the maximum extent practicable, uses appropriate information technology to reduce burden and improve data quality, agency efficiency and responsiveness to the public.

§1320.8(b)(3)

[…]

(b) Such office shall ensure that each collection of information:

[…]

(3) Informs and provides reasonable notice to the potential persons to whom the collection of information is addressed of—

(i) The reasons the information is planned to be and/or has been collected;

(ii) The way such information is planned to be and/or has been used to further the proper performance of the functions of the agency;

(iii) An estimate, to the extent practicable, of the average burden of the collection (together with a request that the public direct to the agency any comments concerning the accuracy of this burden estimate and any suggestions for reducing this burden);

(iv) Whether responses to the collection of information are voluntary, required to obtain or retain a benefit (citing authority), or mandatory (citing authority);

(v) The nature and extent of confidentiality to be provided, if any (citing authority); and

(vi) The fact that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

[…]

1 Leave blank for new forms. For form renewals, the OMB Control Number should be at the top of the OPIC form and also at the top of both the 60 Day and 30 Day Notices.

2 Items 5-6 should be no unless indicated otherwise by the Administrative Attorney. If you believe one of these items should be answered “yes,” please consult with the Administrative Attorney.

3 You may reuse the abstract from your 60 Day and 30 Day Notices.

4 Items 6-10 should be no unless indicated otherwise by the Administrative Attorney. If you believe one of these items should be answered “yes,” please consult with the Administrative Attorney.

5 OCIO determines whether Privacy Impact Assessments (PIAs) are necessary whenever there is a new or changed collection of personally identifiable information (PII). When you submitted a Privacy Threshold Analysis (PTA) to the CISO, he should have informed you if a PIA was necessary. If it was not necessary, answer NO. If it was necessary, consult with the Administrative Attorney and the CISO on whether you are filing your PIA with OMB at this time as a joint package (YES) or as two separate packages (NO).

6 This is the same as the “Authority for Information Collection” in the 60 and 30 Day Notices.

7 The citation can be found on the Federal Register posting for your Notice and is in the sidebar on the right side of the screen. Alternately you can refer to the PDF version of the Federal Register posting, placing the volume number before the “FR” and the page number of the first page of your notice after the “FR.” 69 FR 9783 is shorthand for Federal Register, volume 69, page 9783.

8 This citation will not be available until the 30 Day Notice is published and therefore this field cannot be completed until right before OMB submission.

9 Same as question 25.

10 The GS schedule can be found at http://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/

11 This will be blank unless indicated otherwise by Administrative Attorney.

12 This should be the same as the “Number of Responses” field on your 60 and 30 Day Notices

13 Note that the OMB system does not allow time periods smaller than one year. If your form is filled out only once per project or investor, then type “1” here and explain under item 12 in the Supporting Statement.

14 Please use $75.00/hour to determine the public cost. This will ensure consistency in our calculations for OMB. Therefore if it takes the average respondent 2 hours to fill out the form, you would write $150.00 on line A. ($75.00 x 2)

15 This refers to the time actually spent completing the form.

16 This refers to time spent maintaining records that they would not otherwise maintain except that the records are needed to complete your information collection. For example, if you require them to maintain special financial statements in order to complete your information collection, but they would not otherwise create and maintain these special statements. This is usually zero.

17 This refers to time spent creating and publishing new disclosures that they would not otherwise publish except that your form requires them to. For example, if your form requires them to publish their yearly accident rates. This is usually zero.

18 This number should match the answer to question 12 in your supporting statement

19 The previously claimed burden is what OMB previously approved for your form. You can obtain these numbers from the previous OMB submissions or from http://www.reginfo.gov/public/do/PRAMain (Select OPIC under the “Current Inventory” menu.) If your form is new, then this is zero and your increase is due to this being a new information collection.

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