View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 1405-0206	ICR Reference No: 202412-1405-003
Status: Active	Previous ICR Reference No: 201507-1405-003
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Affidavit of Relationship
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/16/2025
	Date Received in OIRA: 12/16/2024
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2028	36 Months From Approved
Responses	2,800	0	0
Time Burden (Hours)	2,800	0	0
Cost Burden (Dollars)	78,400	0	0

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,800	-2,200	2,500	2,500
Annual Time Burden (Hours)	2,800	-2,200	2,500	2,500
Annual Cost Burden (Dollars)	78,400	-61,600	70,000	70,000

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 estimated annual number of respondents is 300 per fiscal year. The annual hour burden is estimated to be 450 hours, based on each respondent taking ninety minutes to complete the AOR. These estimates are based on AOR submissions from the previous fiscal years and consultation with RAs, which have experience with these collections.

Annual Cost to Federal Government: $180,800

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: Daniel Carson 771 204-4835

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