Living Quarters Eligibility Questionnaire; GSA Form 5039

ICR 202309-3090-001

OMB: 3090-0331

Federal Form Document

Forms and Documents
IC Document Collections
ICR Details
202309-3090-001
Received in OIRA
GSA
Living Quarters Eligibility Questionnaire; GSA Form 5039
New collection (Request for a new OMB Control Number)   No
Regular 09/20/2023
  Requested Previously Approved
36 Months From Approved
25 0
25 0
0 0

This information collection activity concerns an agency-specific form, GSA Form 5039, Living Quarters Allowance Eligibility Questionnaire. This form would be completed by job candidates who have been selected for appointment, reassignment, promotion, or transfer to civil service positions in foreign areas (i.e., outside the United States and its territories and possessions). The living quarters allowance is an authority which allows an agency to reimburse the cost of rent for private housing in an overseas area. The purpose of the form is to collect information which is necessary to determine eligibility for this quarters allowance, under the terms of sections 031.12 and 130 of the State Department’s Standardized Regulations (DSSR). The individuals completing this form will be either members of the public (i.e. not yet appointed to Federal service) or existing Federal employees already employed by GSA or currently appointed by a different agency within the Executive Branch of the U.S. Government.

None
None

Not associated with rulemaking

  88 FR 16447 05/16/2023
88 FR 64912 09/20/2023
No

1
IC Title Form No. Form Name
Living Quarters Eligibility Questionnaire; GSA Form 5039 GSA 5039 LIVING QUARTERS ELIGIBILITY QUESTIONAIRE

  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 25 0 0 25 0 0
Annual Time Burden (Hours) 25 0 0 25 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new information collection.

$875
No
    Yes
    Yes
No
No
No
No
Colin Bennett 717 359-7735

  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.
09/20/2023


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