View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 7100-0379	ICR Reference No: 202007-7100-006
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: FRS	Agency Tracking No: FR 28c
Title: Pre-Hire Conflict of Interest Screening Form
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Delegated
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/13/2020
	Date Received in OIRA: 08/13/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2023	36 Months From Approved
Responses	2,300	0	0
Time Burden (Hours)	1,150	0	0
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	2,300	2,300
Annual Time Burden (Hours)	1,150	1,150
Annual Cost Burden (Dollars)	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The Board implemented the FR 28c form to collect information regarding a prospective external candidate’s potential conflicts of interest after the external applicant has been selected to interview at the Board, but before an offer of employment has been extended.

Annual Cost to Federal Government: $0

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. Yes

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. Yes

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? No

Agency Contact: Robert Dahl 202 622-3119 Robert.Dahl@do.treas.gov

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