Certification of Identity for Freedom of Information and Privacy Act Requests

Forms and Documents

Document Name	Status
Form 3975 Certificate of Identity - FDA Form 3975 Form	New
Supporting Statement FINAL 4-25-2017.doc Supporting Statement A	2017-04-25

IC Document Collections

IC ID	Document Title	Status
226535	Certificate of Identity - FDA Form 3975 Form	New

ICR Details

OMB Control No: 0910-0832	ICR Reference No: 201704-0910-012
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/FDA	Agency Tracking No: ORA
Title: Certification of Identity for Freedom of Information and Privacy Act Requests
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 without change	Conclusion Date: 06/12/2017
	Date Received in OIRA: 04/28/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2020	36 Months From Approved
Responses	60	0	0
Time Burden (Hours)	10	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This ICR collects information from members of the public who submit requests for records about themselves under the Freedom of Information Act (FOIA) and the Privacy Act. The FOIA allows members of the public to request copies of Agency records not normally prepared for public distribution. The Privacy Act permits an individual to seek access to records about that individual that are maintained in an Agency’s system of records (i.e. the records are retrieved by that individual’s name or other personal identifier). The statutes overlap, and an individual’s request for records about himself is generally processed under both statutes. In some cases, the Agency may need to confirm that the individual making the FOIA or Privacy Act request is indeed the same person named in the agency records. This form would provide the certification that the requester is in fact who he says he is, and that the Agency can release records to that individual even if the records would otherwise be un releasable to the third party under an exemption to the FOIA or Privacy Act.

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Authorizing Statute(s): US Code: 5 USC 552 Name of Law: Freedom of Information Act
  

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:
	81 FR 51455	08/04/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 19049	04/25/2017
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
Certificate of Identity - FDA Form 3975	3975	Certificate of Identity

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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	60	0	0	60	0	0
Annual Time Burden (Hours)	10	0	0	10	0	0
Annual Cost Burden (Dollars)	0	0	0	0	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 data collection.

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Annual Cost to Federal Government: $0

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: 04/28/2017

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