E-Appeal/US Merit Systems Protection Board Appeal Form

Forms and Documents

Document Name	Status
Form MSPB-185 E-Appeal/US Merit Systems Protection Board Appeal Form Form	Modified
Supporting Statement Revised Appeal Form.pdf Supporting Statement A	2006-12-21
OGC Advisory Memo re SSN.pdf Supplementary Document	2006-12-21

IC Document Collections

IC ID	Document Title	Status
32657	E-Appeal/US Merit Systems Protection Board Appeal Form Form	Modified

ICR Details

OMB Control No: 3124-0009	ICR Reference No: 200612-3124-001
Status: Historical Active	Previous ICR Reference No: 200310-3124-001
Agency/Subagency: MSPB	Agency Tracking No:
Title: E-Appeal/US Merit Systems Protection Board Appeal 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: 06/11/2007
	Date Received in OIRA: 12/22/2006
Terms of Clearance: This information collection request is approved as submitted, except for the request to collect the last 4 digits of an appellant's SSN, which is not approved. MSPB will delete this question prior to re-issuing this form.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2010	36 Months From Approved	06/30/2007
Responses	7,150	0	6,300
Time Burden (Hours)	7,150	0	6,300
Cost Burden (Dollars)	0	0	0

---

Abstract: This is a voluntary form completed by persons who file appeals with the U.S. Merit Systems Protection Board. The form serves as a guide to appellants in providing all needed information. It is available both as a static form, which is available on our website and upon request, and as an online interactive application.

---

Authorizing Statute(s): US Code: 5 USC 1204, 1221, 3330a, 7701 Name of Law: Civil Service Reform Act and others
  

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:
	71 FR 55221	09/21/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 75277	12/14/2006
Did the Agency receive public comments on this ICR? Yes

---

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

IC Title	Form No.	Form Name
E-Appeal/US Merit Systems Protection Board Appeal Form	MSPB-185	MSPB Form 185

---

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	7,150	6,300	0	0	850	0
Annual Time Burden (Hours)	7,150	6,300	0	0	850	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: The annual number of responses has increased since the last approval from 6,300 to 7,150. This reflects an increased number of persons who file appeals with the MSPB. The Board has no control over the number of appeals filed, which has remained relatively stable over the years.

---

Annual Cost to Federal Government: $27,390

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)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

---

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: 12/22/2006

---