View Information Collection Request (ICR) Package

OMB Control No: 3090-0329	ICR Reference No: 202306-3090-001
Status: Active	Previous ICR Reference No:
Agency/Subagency: GSA	Agency Tracking No:
Title: Overseas Employment Agreement; GSA Form 5040
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/18/2023
	Date Received in OIRA: 06/14/2023
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2026	36 Months From Approved
Responses	25	0	0
Time Burden (Hours)	25	0	0
Cost Burden (Dollars)	0	0	0

Abstract: This information collection activity concerns an agency-specific form, GSA Form 5040, Overseas Employment Agreement. This form would be completed by job candidates who have been selected for appointment, reassignment, promotion, or transfer to civil service positions in foreign areas (i.e., outside the United States and its territories and possessions). The purpose of the form is to memorialize the types of compensation, allowances and leave benefits that the applicant will receive upon appointment to GSA and placement into the foreign position. The form acknowledges that the Government will provide permanent change of station (PCS) travel and relocation benefits to the employee and requires in return one year (12 months) of agency service following the expenditure. Based on the candidate’s job history and method of selection, the form also documents the various types of allowances and benefits that the employee is eligible for and which the agency is willing to pay for. Some of this information that will be collected and memorialized in this form will be delivered to the job candidate by the staffing human resources specialist through another document, such as a tentative offer letter, or via verbal discussions during the onboarding negotiation process. The individuals completing this form will be either members of the public (i.e. not yet appointed to Federal service) or existing Federal employees already employed by GSA or currently appointed by a different agency within the Executive Branch of the U.S. Government. This is the first public comment period and information collection activity for this agency-specific GSA form.

Authorizing Statute(s): None

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:
	88 FR 9521	02/14/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 37542	06/08/2023
Did the Agency receive public comments on this ICR? Yes

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Overseas Employment Agreement; GSA Form 5040	GSA 5040

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	25	25
Annual Time Burden (Hours)	25	25
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: This is a new information collection.

Annual Cost to Federal Government: $875

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: Colin Bennett 717 359-7735

View ICR - OIRA Conclusion