Civilian Response Corps Database In-Processing Form

OMB Control No: 1405-0168	ICR Reference No: 200906-1405-002
Status: Historical Active	Previous ICR Reference No: 200604-1405-001
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Civilian Response Corps Database In-Processing Form
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/19/2009
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/15/2009
Terms of Clearance: OMB appreciates The Department of State’s commitment to convert this collection to an electronic system. The Department of State is given the full three year clearance in order to devote resources to the conversion of this collection to an electronic system. If this collection has not been converted to an electronic submission by the time it is resubmitted for OMB approval in 2012, it will be given an abbreviated approval due to a lack of GPEA compliance.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2012	36 Months From Approved	08/31/2009
Responses	2,000	0	2,400
Time Burden (Hours)	2,000	0	1,200
Cost Burden (Dollars)	0	0	0

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Abstract: The information collected is an important part of the Department’s responsibility to coordinate U.S. Government planning; institutionalize U.S. Reconstruction and Stabilization (R&S) capacity; and help stabilize and reconstruct societies in transition from conflict or civil strife so they can reach a sustainable path toward peace, democracy, and a market economy. The information gathered will be used to identify Civilian Response Corps members who are available to participate in CRC missions.

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Authorizing Statute(s): PL: Pub.L. 108 - 447 408 Name of Law: Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act,    US Code: 22 USC 2734 Name of Law: State Department Basic Authorities Act of 1956    PL: Pub.L. 110 - 447 62 Name of Law: Reconstruction and Stabilization Civilian Management Act of 2008

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 55	03/24/2004
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 107	06/05/2009
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 Civilian Response Corps Database In-Processing Form DS-4096 Civilian Response Corps Database In-Processing Form

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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	2,000	2,400	0	-400	0	0
Annual Time Burden (Hours)	2,000	1,200	0	800	0	0
Annual Cost Burden (Dollars)	0	0	0	0	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: Burden changes are due to collection revision, form redesign, and elimination of Survey SV-2005-0011.

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Annual Cost to Federal Government: $14,000

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)? No

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Melanne Civic 2026633032 [email protected]

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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: 06/15/2009

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