Application for Political Risk Insurance

Forms and Documents

Document Name	Status
Form DFC‐003 Application for Political Risk Insurance Form and Instruction	Unchanged
DFC-003 - Justification for Non-Substantive Changes.docx Justification for No Material/Nonsubstantive Change	2022-02-16
DFC-003 Application for Political Risk Insurance 190626_OIG_UEI (CLEAN).docx Supplementary Document	2022-02-16
DFC-003 - Justification for Non-Substantive Change.docx Justification for No Material/Nonsubstantive Change	2020-03-09
DFC 003 - 83-I Questionnaire - SIGNED.pdf Supporting Statement B	2019-06-28
DFC-003 - Supporting Statement.docx Supporting Statement A	2020-03-09

IC Document Collections

IC ID	Document Title	Status
236737	Application for Political Risk Insurance Form and Instruction	Unchanged

ICR Details

OMB Control No: 3015-0003	ICR Reference No: 202202-3015-002
Status: Active	Previous ICR Reference No: 202003-3015-002
Agency/Subagency: DFC	Agency Tracking No: DFC‐003
Title: Application for Political Risk Insurance
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/16/2022
	Date Received in OIRA: 02/16/2022
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2022	08/31/2022	08/31/2022
Responses	45	0	45
Time Burden (Hours)	135	0	135
Cost Burden (Dollars)	10,125	0	10,125

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Abstract: The Application for Political Risk Insurance will be the principal document used by the agency to determine the investor’s and the project’s eligibility for political risk insurance and will collect information for underwriting analysis.

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Authorizing Statute(s): PL: Pub.L. 115 - 254 1401 Name of Law: Better Utilization of Investments Leading to Development (BUILD) Act of 2018
  

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 10843	03/22/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 29249	06/21/2019
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Application for Political Risk Insurance	DFC‐003	Application for Political Risk Insurance

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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	45	45	0	0	0	0
Annual Time Burden (Hours)	135	135	0	0	0	0
Annual Cost Burden (Dollars)	10,125	10,125	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: $5,053

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.     No

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.     No

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: 02/16/2022

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