STEP 4-DFC-003 - 83-I Questionnaire September 2023

OMB Information Collection Request (83-I information)
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Is this a new form? No
OMB Control Number: 3015-003
Agency Tracking Number: DFC-003
Form Title: Application for Political Risk Insurance
Is this a “common form” that was developed in conjunction with other agencies? No
Is this a “generic form” that is part of an earlier umbrella clearance? No
Abstract. Please describe the needs and uses for the information collection in 4000 characters or
less:
The Application for Political Risk Insurance will be the principal document used by the agency to
collect information to determine the investor’s and the project’s eligibility for political risk
insurance.
Type of Information Collection:
a. ☐ New information collection
b. ☐ Renewal of existing information collection with no changes
c. ☒ Renewal of existing information collection with changes
d. ☐ Reinstatement of expired information collection with no changes
e. ☐ Reinstatement of expired information collection with changes
Type of Review Requested:
a. ☒ Regular review
b. ☐ Emergency review
Requested expiration date:
a. ☒ Three years (maximum)
b. ☐ Other time period: _____
Does the form contain surveys or censuses that employ statistical methods? No
Does the Supporting Statement serve as a joint Paperwork Reduction Act filing and a Privacy Impact
Assessment? No
Is this form related to the Affordable Care Act? No
Is this form related to the Dodd-Frank Act? No
Is this form related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No
Authorizing Statutes:
Better Utilization of Investments Leading to Development (BUILD) Act of 2018, Public Law 115–254
Does this form propose the creation of a new agency regulation? No
Citation & date for the publication of the 60 Day Notice (example: 69 FR 9783, July 31, 2014): 88 FR
37868, June 9, 2023.
Citation & date for the publication of the 30 Day Notice (example: 71 FR 1438, October 1, 2014): 88
FR 55018, August 14, 2023.

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OMB Information Collection Request (83-I information)

20. A. Total number of responses: 100
B. Time it takes an DFC staff member to review one response (in hours): 1
C. The GS-14 step 1 hourly rate in the DC metro area: $63.43
The total cost to the government (A*B*C): $6,342.50
21. Obligation to Respond:
a. ☐ Mandatory – criminal or civil penalties imposed for failure to respond
b. ☒ 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.
c. ☐ 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. Not applicable
23. Line of Business:
a. International Affairs & Commerce - International Development
24. Privacy Act System of Records:
a. ☒ Not applicable. The CISO informed me upon completion of a Privacy Threshold Analysis
(PTA) that a Privacy Impact Assessment (PIA) was not necessary.
b. ☐ 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.
c. ☐ 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: 100
26. Will this information collection have a significant economic impact on a substantial number of small
entities? No
27. Affected public:
a. ☐ Federal Government
b. ☒ Individuals or households
c. Private Sector
i.
☒ Businesses or other for profits
ii.
☐ Farms
iii.
☒ Not-for-profit institutions
d. ☐ State, Local and Tribal Governments
28. Percentage of respondents reporting electronically: 100%
29. Number of responses per respondent per year: 1

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OMB Information Collection Request (83-I information)

30. Type of Collection and Burden on the public

A. Reporting (filling out the form)
B. Recordkeeping (new record maintenance costs
incurred in order to answer questions on form)
C. Third party disclosure (public disclosures such as SEC
filings or drug warning labels)
D. Total burden per response (sum lines A-C)
E. Total number of respondents (question 25)
F. Number of responses per respondent (question 29)
Total annual burden (line D times line E times line F).

Time per response
(hours)
1.666667
0

Cost per
response
$125
$0

0

$0

1.666667
100
1
166.667

$125
100
1
$12,500

31. If the total annual burden is an increase or decrease in the previously claimed burden, please
explain why in 4000 characters or less.
Decreased number of respondents to more accurately reflect the number of respondents per year.

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OMB Information Collection Request (83-I information)

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:
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b.
c.
d.

It is necessary for the proper performance of agency functions;
It avoids unnecessary duplication;
It reduces burden on small entities;
It uses plain, coherent, and unambiguous terminology that is understandable to
respondents;
e. Its implementation will be consistent and compatible with current reporting and
recordkeeping practices;
f. It indicates the retention period for recordkeeping requirements;
g. It informs respondents of the information called for under 5 CFR 1320.8(b)(3):
i. Why the information is being collected;
ii. Use of information;
iii. Nature of response (voluntary, required for a benefit, or mandatory);
iv. Nature and extent of confidentiality; and
v. 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 (see note in Item 19 of the
instructions);
i. It uses effective and efficient statistical survey methodology; and
j. 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.

____________________________

____________________________
Managing Director

___________________
9/7/23

Signature of Senior Official

Title

Date

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OMB Information Collection Request (83-I information)

§ 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:
[…]
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OMB Information Collection Request (83-I 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.
[…]

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