DoD Child Development Program (CDP) - Criminal History

Forms and Documents

Document Name	Status
Form DDX656 Form and Instruction Form and Instruction	New
PIA (Sec 1-2).pdf Supplementary Document	2014-04-29
SORN - NAVY.docx Supplementary Document	2014-01-23
SORN - ARMY.docx Supplementary Document	2014-01-23
SORN - AIR FORCE.docx Supplementary Document	2014-01-23
Supporting Statement - X656 - FINAL (4-24-14).docx Supporting Statement A	2014-04-29

IC Document Collections

IC ID	Document Title	Status
210117	Form and Instruction Form and Instruction	New

ICR Details

OMB Control No: 0704-0516	ICR Reference No: 201401-0704-005
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOD/DODDEP	Agency Tracking No:
Title: DoD Child Development Program (CDP) - Criminal History
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/09/2014
	Date Received in OIRA: 01/30/2014
Terms of Clearance: This collection is approved based on the revised materials provided by the Department.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2017	36 Months From Approved
Responses	5,000	0	0
Time Burden (Hours)	833	0	0
Cost Burden (Dollars)	6,050	0	0

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Abstract: This form is used for non-Federal applicants to apply for employment. The information from this form is used to annotate employees understanding of the background check requirements and obtain information in regards to any criminal history that might prevent an individual from being employed at CDP.

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Authorizing Statute(s): None

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 54632	09/05/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 4888	01/30/2014
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
Form and Instruction	DDX656	BASIC CRIMINAL HISTORY AND STATEMENT OF ADMISSION

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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	5,000	0	0	5,000	0	0
Annual Time Burden (Hours)	833	0	0	833	0	0
Annual Cost Burden (Dollars)	6,050	0	0	6,050	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new form and new collection being requested.

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Annual Cost to Federal Government: $5,500

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: 01/30/2014

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