View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 3420-0036	ICR Reference No: 201711-3420-003
Status: Historical Active	Previous ICR Reference No: 201411-3420-004
Agency/Subagency: OPIC	Agency Tracking No: OPIC-252
Title: U.S. Effects Screening Questionnaire
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/08/2018
	Date Received in OIRA: 11/28/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2021	36 Months From Approved	01/31/2018
Responses	100	0	200
Time Burden (Hours)	213	0	600
Cost Burden (Dollars)	15,938	0	15,000

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	100	200	-100
Annual Time Burden (Hours)	213	600	-387
Annual Cost Burden (Dollars)	15,938	15,000	938

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: Corrections to previously incorrectly submitted numbers bring the burden down and a change in one question to prompt more detail increased the burden slightly.

Annual Cost to Federal Government: $16,104

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? Uncollected

Agency Contact: James Bobbitt 202 336-8558 james.bobbitt@opic.gov

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