Supporting Statement A -3206-0248 - 6-21-21

Supporting Statement A
Paperwork Reduction Act Submission
OMB Control Number 3206-0248
OPM Form 1655 – Application for Senior Administrative Law Judge
OPM Form 1655-A – Geographic Preference Statement for Senior Administrative Law
Judge Applicant
Justification:
1. Explain the circumstances that make the collection of information necessary.
Identify any legal or administrative requirements that necessitate the collection.
Attach a copy of the appropriate section of each statute and regulation
mandating or authorizing the collection of information.
Title 5 U.S.C. § 3323(b), 5 CFR 930.204(b), and 5 CFR 930.209 describe the Office
of Personnel Management’s (OPM) role in managing the Senior Administrative Law
Judge (ALJ) Program and define the rules and regulations that govern the program.
This program allows retired ALJs to be reemployed as Senior ALJs to hear and
decide agency cases in a variety of subject matters. OPM currently maintains a Senior
ALJ Master List of retired ALJs who are available to serve as Senior ALJs. They are
required to submit an application for reemployment and proof of licensure and to
answer a series of questions regarding geographic and personal preferences.
2. Indicate how, by whom, and for what purpose the information is to be used.
Except for a new collection, indicate the actual use the agency has made of the
information received from the current collection.
OPM Form 1655 is an application form used to capture the necessary information
required for reemployment as a Senior ALJ. The creation of this form streamlined the
application process for the Senior ALJ position by allowing the retired judges to place
all of their requested information on these tailored forms. In addition, it allows for
easier data entry, and eliminated the need for further contact with Senior ALJ
applicants for additional information.
3. Describe whether, and to what extent, the collection of information involves the
use of automated, electronic, mechanical, or other technological collection
techniques or other forms of information technology, e.g., permitting electronic
submission of responses, and the basis for the decision for adopting this means of
collection. Also describe any consideration of using information technology to
reduce burden.
Improved information technology will do little to reduce the burden. The information
collected cannot be obtained from other sources. The forms are available on the OPM
website and are downloadable in a PDF format.
4. Describe efforts to identify duplication. Show specifically why any similar
information already available cannot be used or modified for use for the
purposes described in Item 2 above.
The forms are filed individually. Duplication is minimized.

5. If the collection of information impacts small businesses or other small entities
(Item 5 of OMB Form 83-I), describe any methods used to minimize.
This collection of information does not affect small businesses or other small entities.
6. Describe the consequence to Federal/DHS program or policy activities if the
collection of information is not conducted, or is conducted less frequently, as well
as any technical or legal obstacles to reducing burden.
Senior ALJs hear and decide cases involving a variety of subject matters. According
to 5 CFR 930.209, they must be deemed qualified to serve as a Senior ALJ as defined
by OPM regulations. Insufficient collection of information could result in
noncompliance with law and regulation.
7. Explain any special circumstances that would cause an information collection to
be conducted in a manner:
 requiring respondents to report information to the agency more often than
quarterly;
 requiring respondents to prepare a written response to a collection of
information in fewer than 30 days after receipt of it;
 requiring respondents to submit more than an original and two copies of any
document;
 requiring respondents to retain records, other than health, medical,
government contract, grant-in-aid, or tax records, for more than three years;
 in connection with a statistical survey, that is not designed to produce valid
and reliable results that can be generalized to the universe of study;
 requiring the use of a statistical data classification that has not been reviewed
and approved by OMB;
 that includes a pledge of confidentiality that is not supported by authority
established in statute or regulation, that is not supported by disclosure and
data security policies that are consistent with the pledge, or which
unnecessarily impedes sharing of data with other agencies for compatible
confidential use; or
 requiring respondents to submit proprietary trade secrets, or other
confidential information unless the agency can demonstrate that it has
instituted procedures to protect the information's confidentiality to the
extent permitted by law.
OPM Forms 1655 and 1655-A do not meet the criteria listed under item 7.
8. Federal Register Notice: Provide a copy and identify the date and page number
of the publication in the Federal Register of the agency’s notice soliciting
comments on the information collection prior to submission to OMB.
On May 18, 2021, a 60 Day Federal Register Notice was published at Vol. 86 No. 94.

9. Explain any decision to provide any payment or gift to respondents, other than
remuneration of contractors or grantees.
Payments are not applicable. Individuals voluntarily complete OPM Forms 1655 and
1655-A.
10. Describe any assurance of confidentiality provided to respondents and the basis
for the assurance in statute, regulation, or agency policy.
OPM Forms 1655 and 1655-A contain a Privacy Act Statement.
11. Provide additional justification for any questions of a sensitive nature, such as
sexual behavior and attitudes, religious beliefs, and other matters that are
commonly considered private. This justification should include the reasons why
the agency considers the questions necessary, the specific uses to be made of the
information, the explanation to be given to persons from whom the information
is requested, and any steps to be taken to obtain their consent.
This information collection does not include questions that are of a sensitive nature,
such as sexual behavior and attitudes, religious beliefs, and other matters that are
commonly considered private.
12. Provide estimates of the hour burden of the collection of information. The
statement should:
a. Indicate the number of respondents, frequency of response, annual hour
burden, and an explanation of how the burden was estimated. Unless directed to
do so, agencies should not conduct special surveys to obtain information on
which to base hour burden estimates. Consultation with a sample (fewer than
10) of potential respondents is desired. If the hour burden on respondents is
expected to vary widely because of differences in activity, size, or complexity,
show the range of estimated hour burden, and explain the reasons for the
variance. Generally, estimates should not include burden hours for customary
and usual business practices.
b. If this request for approval covers more than one form, provide separate
hour burden estimates for each form and aggregate the hour burdens in Item 13
of OMB Form 83-I.
c. Provide estimates of annualized cost to respondents for the hour burdens for
collections of information, identifying and using appropriate wage rate
categories. The cost of contracting out or paying outside parties for information
collection activities should not be included here. Instead, this cost should be
included in Item 14.
The estimates below are based on past experience. The only cost to respondents is the
time taken to complete an application. The wage rate used below is based on the
Bureau of Labor and Statistics as of May 2020 for Administrative Law Judges.

Form Name

Application for
Senior
Administrative
Law Judge

Geographic
Preference
Statement for
Senior
Administrative
Law Judge
Applicant

Form
Number

No. of
Respondents

No. of
Responses
per
Respondent

Average
Burden
per
Response
(in
hours)

Total
Annual
Burden
(in
hours)

Average
Hourly
Wage
Rate

Total
Annual
Responde
nt Cost

OPM Form
1655

150

15

.62

94

$49.06

$4,611.64

OPM Form
1655-A

200

54

.34

67

$49.06

$3,287.02

13. Provide an estimate of the total annual cost burden to respondents or record
keepers resulting from the collection of information. (Do not include the cost of any
hour burden shown in Items 12 and 14.)
The cost estimate should be split into two components: (1) a total capital and startup cost component (annualized over its expected useful life); and (b) a total
operation and maintenance and purchase of services component. The estimates
should take into account costs associated with generating, maintaining, and
disclosing or providing the information. Include descriptions of methods used to
estimate major cost factors including system and technology acquisition, expected
useful life of capital equipment, the discount rate(s), and the time period over which
costs will be incurred. Capital and start-up costs include, among other items,
preparations for collecting information such as purchasing computers and software;
monitoring, sampling, drilling and testing equipment; and record storage facilities.
If cost estimates are expected to vary widely, agencies should present ranges of cost
burdens and explain the reasons for the variance. The cost of purchasing or
contracting out information collection services should be a part of this cost burden
estimate. In developing cost burden estimates, agencies may consult with a sample
of respondents (fewer than 10), utilize the 60-day pre-OMB submission public
comment process and use existing economic or regulatory impact analysis associated
with the rulemaking containing the information collection as appropriate.
Generally, estimates should not include purchases of equipment or services, or
portions thereof, made: (1) prior to October 1, 1995, (2) to achieve regulatory
compliance with requirements not associated with the information collection, (3) for
reasons other than to provide information to keep records for the government, or
(4) as part of customary and usual business or private practices.
There are no measurable costs to individual respondents other than time.

14. Provide estimates of annualized cost to the Federal Government. Also, provide a
description of the method used to estimate cost, which should include quantification
of hours, operational expenses (such as equipment, overhead, printing and support
staff), and any other expense that would have been incurred without this collection
of information. You may also aggregate cost estimates for Items 12, 13, and 14 in a
single table.
The estimated annualized cost to the Federal Government is based on the 2021 annual
GS-12/3 salary ($44.57 x 2.5 hours per week x 52 weeks per year = $5,794.10)
support staff used to review and process these applications as part of their general
work assignments.
15. Explain the reasons for any program changes or adjustments reported in Items
13 or 14 of the OMB Form 83-I. Changes in hour burden, i.e., program changes or
adjustments made to annual reporting and recordkeeping hour and cost burden. A
program change is the result of deliberate Federal government action. All new
collections and any subsequent revisions of existing collections (e.g., the addition or
deletion of questions) are recorded as program changes. An adjustment is a change
that is not the result of a deliberate Federal government action. These changes that
result from new estimates or actions not controllable by the Federal government are
recorded as adjustments.
The need for these applications varies; the burden estimates reported here are
estimates based on recent and anticipated future trends.
16. For collections of information whose results will be published, outline plans for
tabulation and publication. Address any complex analytical techniques that will be
used. Provide the time schedule for the entire project, including beginning and
ending dates of the collection of information, completion of report, publication
dates, and other actions.
Information collected on the forms will not be published.
17. If seeking approval to not display the expiration date for OMB approval of the
information collection, explain reasons that display would be inappropriate.
We are not seeking approval to not display the expiration date.
18. Explain each exception to the certification statement identified in Item 19
“Certification for Paperwork Reduction Act Submissions,” of OMB Form 83-I.
There are no exceptions to the certification statement.
B. Collection of Information Employing Statistical Methods
This information collection does not employ statistical methods.