View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
1105-0080
ICR Reference No:
200905-1105-001
Status:
Historical Active
Previous ICR Reference No:
200608-1105-001
Agency/Subagency:
DOJ/LA
Agency Tracking No:
CIV-01
Title:
Annuity Broker Qualification Declaration Form
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
12/30/2009
Retrieve Notice of Action (NOA)
Date Received in OIRA:
11/02/2009
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
12/31/2012
36 Months From Approved
01/31/2010
Responses
300
0
400
Time Burden (Hours)
300
0
400
Cost Burden (Dollars)
15,000
0
20,000
Abstract:
This declaration is to be submitted to determine whether a broker meets the minimum qualifications to be listed as an annuity broker pursuant to Section 11015(b) of Public Law 107-273.
Authorizing Statute(s):
PL:
Pub.L. 107 - 273 11015
Name of Law: 21st Century Department of Justice Appropriations Authorization Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
74 FR 38471
08/03/2009
30-day Notice:
Federal Register Citation:
Citation Date:
74 FR 51877
10/08/2009
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Annuity Broker Qualification Declaration Form
1105-0080
Annuity Broker Qualification Declaration Form
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
300
400
0
-100
0
0
Annual Time Burden (Hours)
300
400
0
-100
0
0
Annual Cost Burden (Dollars)
15,000
20,000
0
-5,000
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:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
The Department of Justice has slightly reduced its estimate of the number of annual respondents to this information collection from 400 to 300. The Department of Justice believes, based on its experience with this information collection over the past several years, that 300 is a more likely estimate than 400.
Annual Cost to Federal Government:
$1,000
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
Uncollected
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
Uncollected
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Holly Cummings 202 616-8048 Holly.Cummings@usdoj.gov
Common Form ICR:
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:
(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:
11/02/2009
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