Combined Federal Campaign Results Form

Forms and Documents

Document Name	Status
Form OPM 1417 Combined Federal Campaign Results Form Form and Instruction	Unchanged
2011 Form 1417 - Changes 2011.doc Supplementary Document	2011-11-17
Supporting Statement (3-11) (2).doc Supporting Statement A	2011-10-18
30 day notice.pdf Supplementary Document	2011-10-17
60 day notice.pdf Supplementary Document	2011-10-17

IC Document Collections

IC ID	Document Title	Status
33675	Combined Federal Campaign Results Form Form and Instruction	Unchanged

ICR Details

OMB Control No: 3206-0193	ICR Reference No: 201109-3206-005
Status: Historical Active	Previous ICR Reference No: 200808-3206-001
Agency/Subagency: OPM	Agency Tracking No:
Title: Combined Federal Campaign Results Form
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/28/2011
	Date Received in OIRA: 10/18/2011
Terms of Clearance: This collection is cleared based on the additional materials provided by the agency.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2014	36 Months From Approved	11/30/2011
Responses	247	0	247
Time Burden (Hours)	124	0	124
Cost Burden (Dollars)	0	0	0

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Abstract: In accordance with E. O. 12353 and 5 CFR 950, the Office of Personnel Management collects information from 247 local Combined Federal Campaigns (CFC) to verify national campaign results.

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Authorizing Statute(s): EO: EO 12404 Name/Subject of EO: Campaign Fundraising amended
   EO: EO 12353 Name/Subject of EO: Campaign Fundraising
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
3206-AL05	Final or interim final rulemaking	71 FR 67276	11/06/2006

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 6639	02/07/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 62096	10/06/2011
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
Combined Federal Campaign Results Form	OPM 1417	CFC Campaign Results

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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	247	247	0	0	0	0
Annual Time Burden (Hours)	124	124	0	0	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: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $65,500

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

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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: 10/18/2011

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