Certification of Compliance with Mandatory Bars to Employment

ICR 202108-3064-004 · OMB 3064-0121 · Received in OIRA

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 3064-0121 can be found here:

Forms and Documents

Document	Type	Status	Availability
Form FDIC-2120/16 Certification of Compliance with Mandatory Bars to Employment	Form	Modified	Repair queued
SPST-0121 Certification of Compliance with Mandatory Bars to Employment 2021.docx	Supporting Statement A	Uploaded 2021-12-21	Repair queued
FR2 - 0121 Certification of Compliance with Mandatory Bars to Employment 86 FR 72234 Dec 21 2021.pdf	Supplementary Document	Uploaded 2021-12-21	Repair queued
FR1- 0121 Certification of Compliance with Mandatory Bars to Employment 86 FR 62812 November 12 2021.pdf	Supplementary Document	Uploaded 2021-12-21	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
31915	Certification of Compliance with Mandatory Bars to Employment	Form	Modified

ICR Details

OMB Control No: 3064-0121	ICR Reference No: 202108-3064-004
Status: Received in OIRA	Previous ICR Reference No: 201808-3064-002
Agency/Subagency: FDIC	Agency Tracking No:
Title: Certification of Compliance with Mandatory Bars to Employment
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 12/21/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved	12/31/2021
Responses	528	500
Time Burden (Hours)	88	83
Cost Burden (Dollars)	0	0

Abstract: Prior to an offer of employment, job applicants to the FDIC must sign a certification that they have not been convicted of a felony or been in other circumstances that prohibit persons from becoming employed by or providing services to the FDIC.

Authorizing Statute(s): None

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:
	86 FR 62812	09/22/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 72234	12/21/2021
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
Certification of Compliance with Mandatory Bars to Employment	FDIC-2120/16	Applicant Certification Statement

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	528	500	28
Annual Time Burden (Hours)	88	83	5
Annual Cost Burden (Dollars)	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: $0

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: Manuel Cabeza 202 898-3781 [email protected]

Common Form ICR: No