VA Police Officer Pre-Employment Screening Checklist

OMB Control No: 2900-0524	ICR Reference No: 201611-2900-013
Status: Historical Active	Previous ICR Reference No: 201303-2900-004
Agency/Subagency: VA	Agency Tracking No: 2900-0524
Title: VA Police Officer Pre-Employment Screening Checklist
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 12/01/2016
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/01/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/30/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2017	4 Months From Approved
Responses	1,500	0	0
Time Burden (Hours)	250	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The form serves as a record of pre-employment screening to determine the qualification and suitability of the applicant.

Emergency Justfication: The VA Form 0120, VA Police Officer Pre-employment Screening Checklist, involves thorough pre-employment screening and special background checks for police officer applicants. It also provided a record of pre-employment screening in conformance with selection standards that ensure that Federal criminal law enforcement authority is granted cautiously and responsibly

---

Authorizing Statute(s): US Code: 38 USC 512 Name of Law: Delegation of authority; assignment of functins and duties    US Code: 38 USC 3301 Name of Law: Civil service; generally

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:
	81 FR 86073	11/29/2016
Did the Agency receive public comments on this ICR? No

---

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

IC Title Form No. Form Name VA Police Officer Pre-Employment Screening Checklist VA Form 0120 VA Police Officer Pre-Employment Screening Checklist

---

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	1,500	0	0	0	0	1,500
Annual Time Burden (Hours)	250	0	0	0	0	250
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: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $6,387

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: Cynthia Harvey - Pryor 202 461-5870 [email protected]

---

Common Form ICR:  No

---

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: 11/30/2016

---