Temporary Contractor Information Worksheet; GSA Form 850

Forms and Documents

Document Name	Status
Form GSA Form 850 Temporary Contractor Information Worksheet, GSA Form 850 Form and Instruction	New
JUSTIFICATION OMB Control Number Temporary Contractor Information Worksheet.doc Supporting Statement A	2009-05-04

IC Document Collections

IC ID	Document Title	Status
188501	Temporary Contractor Information Worksheet, GSA Form 850 Form and Instruction	New

ICR Details

OMB Control No: 3090-0283	ICR Reference No: 200903-3090-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: GSA	Agency Tracking No:
Title: Temporary Contractor Information Worksheet; GSA Form 850
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 03/25/2009
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/05/2009
	Date Received in OIRA: 03/23/2009
Terms of Clearance: This collection is approved with the following terms of clearance. This collection is approved as an emergency clearance to meet the American Reinvestment Recovery Act requirements. The collection is only valid for 6 months. If GSA decides to continue to use of this collection past the approved emergency request time period, it must resubmit to OMB under the normal PRA clearance process for a three year approval.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2009	6 Months From Approved
Responses	24,480	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: GSA requires the collection of the information in the Temporary Contractor Information Worksheet to authorize and initiate investigation requests for GSA temporary contractors on GSA contracts related to the American Recovery and Reinvestment Act of 2009 to grant unescorted access to GSA-controlled facilities. The background investigations and adjudication of results are carried out by the US Department of Homeland Security, Immigration and Customs Enforcement, Federal Protective Service (DHS/ICE/FPS) Contractor Suitability and Adjudication Division in accordance with the terms and conditions of separate Memoranda of Agreement (MOAs) with GSA.

Emergency Justfication: The GSA Form 850 must be approved for temporary use so that GSA can authorize and initiate investigation requests for GSA contractors and child care workers and prevent delays to the work start dates for contractors related to the American Recovery and Reinvestment Act of 2009.

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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

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
Temporary Contractor Information Worksheet, GSA Form 850	GSA Form 850	Temporary Contractor Information Worksheet

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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	24,480	0	0	24,480	0	0
Annual Time Burden (Hours)	0	0	0	0	0	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:

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Annual Cost to Federal Government:

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)? Yes

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: 03/23/2009

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