SUPPORTING STATEMENT FOR
PAPERWORK REDUCTION ACT SUBMISSION
Government,
Corporate or Foundation, and Individual Donor Form
OMB Number 1405-0218
DS-4271,
DS-4272, DS-4273
Use the following format for each numbered item 1 through 18. Do not include the numbered item descriptor. Listed for each question is a brief synopsis of what information is required. Contact DIR for assistance if necessary.
Why is this collection necessary and what are the legal statutes that allow this?
The Office of Emergencies in the Diplomatic and Consular Services (EDCS) manages the solicitation and acceptance of gifts to the U.S. Department of State. The information requested via donor forms is a necessary first step in accepting donations. The information sought is pursuant to 22 U.S.C 2697, 5 U.S.C. 7342 and 22 CFR, part 3.
What business purpose is the information gathered going to be used for?
The information collected will be used by EDCS’s Gift Fund Coordinator to demonstrate the donor’s intention to donate either an in-kind or monetary gift to the Department. Collection of this information is mandatory, and a form must be completed before the gift is received by the Department.
Is this collection able to be completed electronically (e.g. through a website or application)?
Donors can request and complete an electronic copy of the form from program offices who have authority to solicit and accept on behalf of the Department. After completion, donor form are submitted through two methodologies. Option 1 (Electronically): The soliciting program officer will send the Donor Form electronically (retrieved from the Departments’ internal myData Forms used for printing and electronic submissions) to recipients who will complete it and return to EDCS at MEDCS@state.gov. The donors submit their payments through the Global Financial Operations (CGFS/GFO) where they provide financial instructions for the remittance of Automated Clearing House (ACH) credits to the United States Department of State. Option 2: (Hard Copy): The soliciting program officer will send the Donor Form electronically and the donor will print and mail the form with a personal check or money order and return to EDCS by mail at 2201 C Street, NW, Room 1821, Washington, D.C. 20520.
Does this collection duplicate any other collection of information?
EDCS is the only office in the Department managing the donor program so no other office or program is requesting duplicate information from the public.
Describe any impacts on small business.
This collection of information will not have a significant impact on small businesses or other small entities. Small businesses may give in-kind or cash gifts to the Department. The Department estimates it will take a small business 10 minutes to complete a form, put it in an envelope, address it, and mail it to the Department.
What are consequences if this collection is not done?
The collection of the donor forms is how the Department is able to accept cash and in-kind gifts from donors. Correspondingly, the Gift Funds and K Fund Coordinator is responsible for providing an acknowledgment letter to donors for their tax purposes. The information is collected once per donation.
Are there any special collection circumstances?
There are no special circumstances.
Document publication (or intent to publish) a request for public comments in the Federal Register
The Department published a notice in the Federal Register soliciting public comments for a period of 60 days. No comments were received.
Are payments or gifts given to the respondents?
No gifts or payments will be made to respondents.
Describe assurances of privacy/confidentiality
All information will be handled in accordance with the Privacy Act. The Department has made no promises of confidentiality to the respondents.
Are any questions of a sensitive nature asked?
No questions of a sensitive nature are asked.
Describe the hour time burden and the hour cost burden on the respondent needed to complete this collection.
EDCS estimates an average time required for this information collection is 10 minutes. The estimated total annual burden for this collection:
5,000 (estimated respondents for FY22) x 10 (minutes per form) / 60 = 833 hours per year.
The estimated number of minutes required per response is based on typed or written information required on the appropriate donor form: Government, Corporate or Foundation, and Individual. The donor must complete all required fields on the form, review both pages, and email or mail the document with the monetary gift. Forms that are mailed require a forwarding and return address, envelope, postage, and postal carrier. The donor may opt to email the completed form to the program office responsible for accepting the donation. The program office will forward the package to EDCS for processing.
The hourly cost to respondents for the donor forms are calculated by the hourly wage and weighted multiplier. The wage rate category for “All Occupation” code 00-000, $29.76 (mean hourly wage), based on the U.S. Department of Labor, Bureau of Labor Statistics website www.bls.gov x 1.8 wage rate multiplier1.
$29.76 x 1.8 = $54 wage rate
833 (annual hours) x $54 (wage rate) = $44.98 yearly hour burden cost
Describe the monetary burden to respondents (out of pocket costs) needed to complete this collection.
There will be no capital or start-up costs necessary for respondents. The only additional operation cost would be postage for the respondents to return the form to the Department. The cost of postage increased since the last renewal. The Department estimates 4,079 forms mailed at 58 cents each for a total of $2,750.
Describe the cost incurred by the Federal Government to complete this collection.
The estimated cost to the USG for the Donor Form collections is $126,243. The estimate includes costs for the Program Analyst GS-13, step 3 equivalent - $57.25 per hour2. The Analyst will process each form – opening the envelope, recording the information in a database, and sending a letter of acknowledgment back to the donor. Additional costs include employees benefits and overhead costs to the employer (supplies).
Total Cost to Federal Government
Cost Items |
Total |
Federal Staff Costs [indicate grade and step, percentage of time]
|
$119,482 |
Employee Benefits |
$6,233.28 |
Supplies (address labels, envelops, postage) |
$527.62 |
Total |
$126,243 |
Explain any changes/adjustments to this collection since the previous submission
Since the previous renewal, donations from government, individuals, corporations, and foundations slightly decreased by 8%. Donations vary due to political, environmental, and economic stability.
Specify if the data gathered by this collection will be published.
The information gathered via this information collection will not be published.
If applicable, explain the reason(s) for seeking approval to not display the OMB expiration date. Otherwise, write “The Department will display the OMB expiration date.”
The Department will display the OMB expiration date on all versions of the forms.
Explain any exceptions to the OMB certification statement below.
The Department is not seeking exceptions to the certification statement.
This collection does not employ statistical methods.
1 Source: U.S. Bureau of Labor Statistics, May 2022, https://www.bls.gov/oes/current/oes_nat.htm#00-0000. National Occupational Employment and Wage Estimates for “All Occupations”.
2 Source: Office of Personnel Management, “2022 General Schedule and Locality pay” for Washington-Baltimore-Arlington, DC-MD, VA-PA. https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/2022/locality-pay-area-definitions/
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Canfield, Danielle P |
| File Modified | 0000-00-00 |
| File Created | 2024-07-20 |