View Information Collection Request (ICR) Package
Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
This script is used to control the display of information in this page.
Display additional information by clicking on the following:
All
Brief and OIRA conclusion
Abstract/Justification
Legal Statutes
Rulemaking
FR Notices/Comments
IC List
Burden
Misc.
Common Form Info.
Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
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:
0704-0588
ICR Reference No:
202209-0704-004
Status:
Active
Previous ICR Reference No:
201905-0704-007
Agency/Subagency:
DOD/DODDEP
Agency Tracking No:
0704-AABZ
Title:
PFPA Recruitment, Medical, and Fitness Forms
Type of Information Collection:
Extension without change of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
02/10/2023
Retrieve Notice of Action (NOA)
Date Received in OIRA:
11/30/2022
Terms of Clearance:
This collection is approved based on the revised materials provided by the Department.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
02/28/2026
36 Months From Approved
02/28/2023
Responses
3,600
0
3,600
Time Burden (Hours)
520
0
520
Cost Burden (Dollars)
13,920
0
14,040
Abstract:
This information collection is essential to PFPA and is used to make a determination of fitness for federal employment in the field of law enforcement. To that end, criminal, background and medical information is collected on the applicants.
Authorizing Statute(s):
US Code:
5 USC 3304
Name of Law: Competitive service; examinations
US Code:
5 USC 3318
Name of Law: Competitive service; selection from certificates
US Code:
5 USC 9101
Name of Law: Access to criminal history records for national security and other purposes
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:
87 FR 58078
09/23/2022
30-day Notice:
Federal Register Citation:
Citation Date:
87 FR 72974
11/28/2022
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
6
IC Title
Form No.
Form Name
1. Application Status Request (PFPA Form 1408)
PFPA Form 1408
Application Status Request
Authorization for Release of Information (PFPA Form 1400)
PFPA Form 1400
Authorization for Release of Information
Character Reference Questionnaire (PFPA Form 1409)
PFPA Form 1409
Character Reference Questionnaire
Employer Reference Questionnaire (PFPA Form 1410)
PFPA Form 1410
Employer Reference Questionnaire
Internal Affairs Request (PFPA Form 1407)
PFPA Form 1407
Internal Affairs Request
Supplemental Medical History Questionnaire (PFPA Form 6040)
PFPA Form 6040
Supplemental Medical History Questionnaire
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
3,600
3,600
0
0
0
0
Annual Time Burden (Hours)
520
520
0
0
0
0
Annual Cost Burden (Dollars)
13,920
14,040
0
-120
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:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$314,027
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:
Dajonte Holsey 703 571-2939 dajonte.l.holsey.civ@mail.mil
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:
11/30/2022
An official website of the United States government
The .gov means it's official.
The site is secure.
