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

ICR 202111-0704-003

OMB: 0704-0551

Federal Form Document

Forms and Documents
ICR Details
0704-0551 202111-0704-003
Received in OIRA 201901-0704-002
DOD/DODDEP 0704-AAIU
Office of the Secretary of Defense Confidential Conflict-of-Interest Statement for Advisory Committee Members
Extension without change of a currently approved collection   No
Regular 02/22/2022
  Requested Previously Approved
36 Months From Approved 03/31/2022
125 125
125 125
906 906

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.

EO: EO 12674 Name/Subject of EO: Principles of Ethical Conduct for Government Officers and Employees
   US Code: 5 USC app., sec. 107(a) Name of Law: The Ethics in Government Act of 1978
  
None

Not associated with rulemaking

  86 FR 66542 11/23/2021
87 FR 9586 02/22/2022
No

  Total Request 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 125 125 0 0 0 0
Annual Time Burden (Hours) 125 125 0 0 0 0
Annual Cost Burden (Dollars) 906 906 0 0 0 0
No
No

$4,854
No
    Yes
    Yes
No
No
No
No
Bridget Perras 703 697-8031 bridget.d.perras.civ@mail.mil

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
02/22/2022


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