STATEMENT OF PERSONAL HISTORY

OMB Control No: 3245-0007	ICR Reference No: 198401-3245-011
Status: Historical Inactive	Previous ICR Reference No: 198205-3245-004
Agency/Subagency: SBA	Agency Tracking No:
Title: STATEMENT OF PERSONAL HISTORY
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Disapproved and continue	Conclusion Date: 03/15/1984
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/03/1984
Terms of Clearance: Agency completed SF-83 incorrectly for this request. Should have marked Item 15 as "New," per Desk Officer, 03/16/84.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/1985	05/31/1985	05/31/1985
Responses	34,000	0	34,000
Time Burden (Hours)	34,000	0	34,000
Cost Burden (Dollars)	0	0	0

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Abstract: THIS FORM IS USED TO COLLECT INFO. NEEDED TO MAKE CHARACTER DETERMINATIONS WITH RESPECT TO APPLICANTS FOR ASSISTANCE OR FOR TEMPORARY EMPLOYMENT IN DISASTER OFFICES. THE INFO. SOLICITED IS USED AS THE BASIS FOR CONDUCTING NAME INDICES CHECKS AT THE NATIONAL AND IN SOME CASES STATE OR LOCAL LEVELS.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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

IC Title Form No. Form Name STATEMENT OF PERSONAL HISTORY 912

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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:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 01/03/1984

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