Pre-Hire Conflict of Interest Screening Form

Forms and Documents

Document Name	Status
FR28c_20200813_omb.pdf Supporting Statement A	2020-08-13

IC Document Collections

IC ID	Document Title	Status
242749	FR 28c Other-Draft Form	New

ICR Details

OMB Control No: 7100-0379	ICR Reference No: 202007-7100-006
Status: Active	Previous ICR Reference No:
Agency/Subagency: FRS	Agency Tracking No: FR 28c
Title: Pre-Hire Conflict of Interest Screening Form
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Delegated
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/13/2020
	Date Received in OIRA: 08/13/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2023	36 Months From Approved
Responses	2,300	0	0
Time Burden (Hours)	1,150	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The FR 28c form collects information from external applicants applying to the Board regarding certain financial interests or business relationships held by the applicant and by their immediate family members, as well as the external applicant’s involvement with certain outside organizations to determine whether a conflict of interest may exist, which could impact the applicant’s ability to fulfill the responsibilities associated with the position for which they have applied.

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Authorizing Statute(s): US Code: 12 USC 244 Name of Law: Federal Reserve 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:
	85 FR 2741	01/16/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 38893	06/29/2020
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
FR 28c

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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	2,300	0	0	2,300	0	0
Annual Time Burden (Hours)	1,150	0	0	1,150	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: The Board implemented the FR 28c form to collect information regarding a prospective external candidate’s potential conflicts of interest after the external applicant has been selected to interview at the Board, but before an offer of employment has been extended.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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? No

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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: 08/13/2020

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