Office of the Secretary of Defense (OSD) Confidential Conflict-of-Interest Statement for Advisory Committee Members

Forms and Documents

Document Name	Status
Form SD Form X682 Office of the Secretary of Defense (OSD) Confidential Conflict-of-Interest Statement for Advisory Committee Members Form and Instruction	New
Supporting Statement OSD Confidential Conflict of Interest Form ICB EDITS (SOCO 12-28-15 edits) (2).DOC Supporting Statement A	2016-01-15

IC Document Collections

IC ID	Document Title	Status
219594	Office of the Secretary of Defense (OSD) Confidential Conflict-of-Interest Statement for Advisory Committee Members Form and Instruction	New

ICR Details

OMB Control No: 0704-0551	ICR Reference No: 201601-0704-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOD/DODDEP	Agency Tracking No: 0704-AAIU
Title: Office of the Secretary of Defense (OSD) Confidential Conflict-of-Interest Statement for Advisory Committee Members
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/18/2016
	Date Received in OIRA: 01/15/2016
Terms of Clearance: DOD must report this collection as a violation in this year's Information Collection Budget.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2019	36 Months From Approved
Responses	125	0	0
Time Burden (Hours)	125	0	0
Cost Burden (Dollars)	906	0	0

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Abstract: The information request on this form is required by Title I of the Ethics in Government Act of 1978 (U.S.C. App.), Executive Order 12674, and 5 C.F.R. part 2634, subpart I, of the Office of Government Ethics regulations. The requested information is necessary to prevent conflicts of interest and to identify potential conflicts of individuals serving on certain OSD Advisory Committees.

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Authorizing Statute(s): US Code: 5 USC app., sec. 107(a) Name of Law: The Ethics in Government Act of 1978
   EO: EO 12674 Name/Subject of EO: Principles of Ethical Conduct for Government Officers and Employees
  

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:
	80 FR 19641	04/13/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 2203	01/15/2016
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
Office of the Secretary of Defense (OSD) Confidential Conflict-of-Interest Statement for Advisory Committee Members	SD Form X682	Office of the Secretary of Defense (OSD) Confidential Conflict-of-Interest Statement for Advisory Committee Members

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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	125	0	0	125	0	0
Annual Time Burden (Hours)	125	0	0	125	0	0
Annual Cost Burden (Dollars)	906	0	0	906	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: There is a change in burden because this is an existing collection without an OMB Control Number.

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Annual Cost to Federal Government: $4,854

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: 01/15/2016

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