Applicant Background Questionnaire

OMB Control No: 3046-0046	ICR Reference No: 201310-3046-002
Status: Historical Active	Previous ICR Reference No: 201205-3046-001
Agency/Subagency: EEOC	Agency Tracking No:
Title: Applicant Background Questionnaire
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  Yes
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/10/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/01/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2017	36 Months From Approved	02/28/2014
Responses	5,800	0	26,854,281
Time Burden (Hours)	290	0	1,342,714
Cost Burden (Dollars)	0	0	0

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Abstract: The Demographic Information on Applicants form is designed to enable federal agencies to evaluate their employment practices by collecting and analyzing data on the race, national origin, sex and disability status of applicants for employment.

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Authorizing Statute(s): US Code: 29 USC 791 Name of Law: Rehabilitation Act 1973    US Code: 42 USC 2000e Name of Law: Title VII of the Civil Rights Act of 1964

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:
	78 FR 11175	02/15/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 56696	09/13/2013
Did the Agency receive public comments on this ICR? Yes

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

IC Title Form No. Form Name Applicant Background Questionnaire 3046-0046 Demographic Information on Applicants

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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	5,800	26,854,281	0	-26,848,481	0	0
Annual Time Burden (Hours)	290	1,342,714	0	-1,342,424	0	0
Annual Cost Burden (Dollars)	0	0	0	0	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The Applicant Background Questionnaire was not previously a common form. Now that we intend to host it as a common form, EEOC must only include an estimate of its own burden associated with the IC.

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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]? 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? Uncollected

Agency Contact: Dexter Brooks 202 663-4511

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Common Form ICR:  Yes

OIRA authorizes any Agency to begin using a Common Form associated with this ICR automatically after 5 calendar days from the date the agency's RCF including the common form was received in OIRA.

Description/Changes for Common Form Usage:  The Commission is charged with reviewing and approving federal agencies' plans to affirmatively address potential discrimination. As a part of this obligation, the Commission has established systems to monitor compliance by requiring agencies to evaluate their recruitment through the collection and analysis of applicant data on the race, national origin, sex, and disability status. This common form will allow federal agencies to consistently collect the required information.

Approved RCFs using this ICR

Agency/Sub Agency RCF ID RCF Title RCF Status IC Title DOI/OEO 201504-1091-001CF DOI Use of Demographic Information on Applicants Form Historical Active Applicant Background Questionnaire DOL/DM 201403-1225-004CF Applicant Background Questionnaire Historical Active Applicant Background Questionnaire DOL/DM 201403-1225-005CF Applicant Background Questionnaire Historical Active Applicant Background Questionnaire DOC/CENSUS 201702-0607-001CF Census Bureau Request to Use the Demographic Information on Applicants for Federal Employment” (Form 3046-0046) Historical Active Applicant Background Questionnaire DOL/DM 201611-1225-012CF Applicant Background Questionnaire Historical Active Applicant Background Questionnaire

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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: 11/01/2013

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