Form 12854, Government Service Information

ICR 202102-1545-030

OMB: 1545-1919

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2021-04-27
IC Document Collections
IC ID
Document
Title
Status
19619 Modified
ICR Details
1545-1919 202102-1545-030
Received in OIRA 201801-1545-017
TREAS/IRS
Form 12854, Government Service Information
Extension without change of a currently approved collection   No
Regular 04/30/2021
  Requested Previously Approved
36 Months From Approved 04/30/2021
24,813 24,813
6,203 6,203
0 0

Form 12854 is used to identify applicants who have had prior government service in order to request the official personnel folder from federal records and to identify possible pay-setting issues.

US Code: 5 USC 5334 Name of Law: Rate on change of position or type of appointment; regulations.
  
None

Not associated with rulemaking

  85 FR 73845 11/19/2020
86 FR 22784 04/29/2021
No

1
IC Title Form No. Form Name
Form 12854, Government Service Information 12854 GOVERNMENT SERVICE INFORMATION

  Total Request 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 24,813 24,813 0 0 0 0
Annual Time Burden (Hours) 6,203 6,203 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$9,586
No
    Yes
    Yes
No
No
No
No
Kimber Kimber 801 620-3632

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
04/30/2021


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