ML20246M008

Request for OMB Review & Supporting Statement Re NRC 212, Qualifications Investigations,Prof. Total Annual Respondent Burden Is 375 H

ML20246M008
Person / Time
Issue date:	03/16/1989
From:	Amenta J NRC OFFICE OF INFORMATION RESOURCES MANAGEMENT (IRM)
To:
References
OMB-3150-0033, OMB-3150-33, NUDOCS 8903270013
Download: ML20246M008 (7)

Text

q,[.

$/C__

S"" * ' '", 8

. Request for ChiB Review =*"g"*g -

o Fet Septernte< 1923)

C

~

Important '

Read instructions before completsng f arm. Do not use the same SF 83 Send 'bree copies of this form, the material to J e reviewed, and for to' request both an Executive Order 12291 renew and approval under paperwork-three copies of the support ng statement. to:

the Paperwork Reduction Act.

Answer all quest:cns in Part 1. If this request is for review under E 0, Office of Information and Regulatory Affairs 12291, complete Part t and sign the regulatory certification. If this Office of Management and Budget reauest is for approvat under the Paperwork Reduction Act and 5 CFR Attention; Docket Library, Room 3201 1320, skip Part it, complete Part 111 and sign the paperwo i' certification.

. Washington, DC 20503 PART l.-Complete This Part for All Requests.

' 1. Departmentage'cy ano Bureau of hee o<pratmg req;est.

2, Agency code U.S.' Nuclear Regulatory Commission.

3 5 0

1 i.

'3, Name of persor, ano can cest answer questions regard:ng th:s request Telephone number

_ Nicholas _ Monaco (301 1 4.92 9600

4. Irtte of information codection or rulemaking NRC 212,- Qualifications' Investigations, Professional S.Legaiaamor,ti br mb'mainori Coilect'on or rute tcite United Sta:es CcJe r'abhc La,s. or Enecutne O' der) 42-2201(o) usC

6. Affected puchticheck a4(9f acry) 5 C Fede alagenc.es or ereployees 1 h.0 vic.a4 or hoasenclos 3 C Farms 6 C Non profit mstitstions 2 C State c +cca!goverwents 4 ] Busmesses o ether ior profit 7 C Small bus nesses or organizations PART ll.-Complete This Part Only if the Request is for OMB Review Under Executive Order 12291

7. Reguiation 'dev.f er N 2mbe'(RIN) r, b e ass gned C

[ Type of submas.on tcheck one m each ca:eio't)

Type of review requested Classification Stage of development 1 C standard 1 C Maror 1 C Proposed or d*z ft 2

Pending -

o ia mths o puposal 3 C ' Emergency 2 C Nonmw 2 U Frale inter m r

3 C Fmal or intenm fma!. without pnor proposal 4

Statutory or ud.cial deadhne

~

s

9. Cf R section a+fected CF8

10. Does this rep.iation conta<n rescrtmg or recordheepq reqam ments that req;ee OMB approval under the Paperwork Reduction Act

. C Yes C No

.o an:5 CFR 1320?

1 C Yes 2 No L t1,if a major r.re is there a regulatory impact analyss attached) 3 Yes 4 No If' ho "dia ofMB waive the analys!s?

Certification for Regulatory submissions in submittmg th s request for oMB review. the autto, zed regulatory contact and the program official certify that the requirements of E.o.12291 and any apphcable pokcy directives have been comphed with

~

Date Signature of ong'am officiai Signatwe of autenzec repatory contact

~

j

! Date I

i

12. (OMB osc oND 1

I standaraosni 8; "go prewo m u w. s e o tu goy r,

www m a s c,, me mm m 4

. 8903270013 890316 l

\\

l PDR ORG EUSOMB

______________P9C.

__ _ ______ l _ _ _____ _ __ _

I' PART 111 -Complete This Part Only if the Request is for Approval of a Collection of Information Under the Paperwork Rcduction Act and 5 CFR 1320.

13. ustract-cem te needs uses and af fected pubiic in 50 words or tess "Ciill Service Appointment, Employment, and Hiring" l

.Information reg'uested 'is used to' determine qualifications and suitability of applicants

- for~ employment in professional positions with the~ NRC.

I ' 14. Type of in8cemation collect,on (cr:ec4 only one)

~ Informesion sal! actions ret gentainedin rules 1 @ Regular submisoon 2 O Emergency submission (certiftcationattached)

Informal lon col! actions containedin rules 3 O Existmg regWat on(no change proposed) 6 Final or intenm final without prior NPRM

7. Enter date of expected or actual Federal 4 0 Notice of proposed rulemaking(NPRM) L A

Regu!ar sabrmsion Register publication at this stage of rulemaking

' 5 C Fina;. NPRM was previously published B C Emergency suomission (certification artsched)

(month, day, year)

15. Type of review requested (che9 only one) 1 O Ne* conect.on 4 0 Re;nstatement of a prev ousiy approved coitection for whicn approvai.

tsat expired

-2 C Revision of a current y approved cot!ection 3 00 Ex,c men of the expirat on date of a currentry' approved conection 5 0 Ex stma coi:ect>on in use witnout an oMB controi number wet cat w ygge in the substance or in the method of collection

16. Agency recc 1 fn Vnter(s)(incluce star > Card /optoona! form nur%er(s))

22. Purpose ct mformation collect on(check as manyas appi )

y 1 b Appheation for benefits

_ NRC 21?

2 O Prog am evatuation

17. Anruai report:rg c discicsae bu cen 3

General purpose statistics r

1*500 1 Number of respondents.

- 4 C Regulatoryor comphance 2 Numoe* cf resce,ses per responce1 5 O Preg am planning or management 3 To'a' arnual responses (tme ) teres I,ne 2) 6 C Research 4 Heurs per res;.onse 7 U Ault S_

5 Tcts; mass r. e 3 times hne 4)

. I 6. Annaa! **co<creennE burden

23. F requency of recordkeepirg or reportmg(check all thatapply) 1 Number o reco dkeepers 1 C 4:orseepmg 8

2 Annua;hoursi:er recorseeoer Reporfml 3 To'.ai recorckeenng nours (se 1 Smer ime 2) 2 b onoccas;on

'. 4 Recor$ eep ng reter.tico penoo years 3 0 WeeMy

19. toy arNai bar:e" 4 O M; nth'y i

375 1 Requested (hne 175 prus bre 18 3).

5 La Vterfy 500 6 0 sew.annuay, 2 fn current OMB nveatory

-125 I

7 C Awally 3 Ddfere ice (rne 1 less fme 2)

Lip!anation cf dif'erence 5 Q Bientually 4 Program change 9 ] other(desenbe).

5 Adystmee

-125 2b. Current (raost rece nt) OMB controi number o* comment number j 24. Respo, dents' cbhgatien to comply (check the strongest obhgation thatapphes)

J H0d O33 1 O vovtary

81. Requested espirattor. date 2

Reauired to cbtain or retain a benefit

_2L27/92 3 O Maneatm

25. Are the respondents pnrr arJy educationalagencies orinstitutions or a the pomary pu pese of the cohection related to Federal education prof

26. Dces the egency use sampimg to select respondents or caes the agency recom r end or prescnde the use of samparg or statistical ar4atysis

. O Yes $ No j

by responcerts?

27. Regv:atory authonty for the mformation collection Cfp

or FR

or. otrer (spectly)

i Paporwork Certification in subtri.tt rg tms req;est *or OMB approval, the agency head, the senior official or an authonzed representative, cert:fies that the requirements of 5 CFR 1320 the

'i Pnvacy Act. statst. cal s'grcardscr directives, and any cther apphc?b!e mformatis pohey cirectwes have been comphed with.

Date Signature of program c fic ai C L-

~

f Date Signature of agency /eJ, thisenior official or an authonzed representatwe bNf J

day.ce - A. Amertta, DSO for Information Resources Ma0Agement i

n v

< on n - c 3.m

)

a SUPPORTING STATEMENT For j

NRC Form 212, " Qualifications Investigation, Professional" (OMB Clearance No. 3150-0033)

Description of Information Collectio_n i

This form is used for investigating the qualifications of external candidates for appointment to professional positions in the Nuclear Regulatory Commission

.(NRC).

A.

Justification 1.

Need for the Collection of Information Information requested on NRC Form 212 is used to determine the qualifications and suitability of applicants for employment in professional positions with the U.S. Nuclear Regulatory Commission.

The completed form may be used to examine, rate and/or assess the prospective employee's qualifications. The information regarding the qualifications of applicants for employment is reviewed by professional personnel of the Office of Personnel, in conjunction with other information in the NRC files, to determine the qualifications of the applicant for appointment to the position under consideration.

2.

Agency Use of Information NRC. Form 212 is sent to former employers, supervisors, and other references indicated on job applications as a part of the investigation for suitability of external candidates for appointment to professional positions. The information obtained on NRC Form 212 is reviewed and evaluated by personnel of the Office of Personnel in determining the qualifications of applicants for employment.

3.

Reduction of Burden Through Information Technology There are no legal obstacles to reducing the burden associated with this information collection through the use of information technology. The nonrecurrence of each individual collection makes it difficult to reduce the burden through the use of technology.

However, the NRC encourages the respondents to use any innovative technology which would reduce burden.

4.

Effort to Identify Duplication Where the NRC has recent references on file and the positions which the applicant applied for are similar, no additional references are requested.

! 5.

Effort to Use Similar Information This information is available only from the individual rater.

6.

Effort to Reduce Small Business Burden Information may be requested from individuals associated with small businesses; however, the amount of information requested is kept to a minimum while still allowing a full investigation.

7.

Consequences of Less Frequent Collection This information has to be collected and reviewed prior to making a decision on employment eligibility.

8.

Circumstances Which Justify Variation from OMB Guidelines Thisrequestdoesnotvarykrm?0MBguidelines.

p 9.

Consultations Outside the NRC There were no consultations outside of NRC.

10. Confidentiality of Information NRC provides no pledge of confidentiality of the evaluation.

However, confidentiality of the name of the rater will be honored upon request, and the form provides for making such a request.

11. Justification for Sensitive Questions Not applicable.

12. Estimated Annualized Cost to the Federal Government i

The total estimated annual cost to the Federal Government for printing, handling, reviewing, and assessing the NRC Form 212 is

$9,000 (150 hours0.00174 days <br />0.0417 hours <br />2.480159e-4 weeks <br />5.7075e-5 months <br /> x $60/ hour).

l I

13. Estimate of Burden and Cost to Industry l

Past experience indicates that responding on this form takes about 15 minutes. The total estimated time to respond to the approximate 1,500 forms used annually is 375 hours0.00434 days <br />0.104 hours <br />6.200397e-4 weeks <br />1.426875e-4 months <br /> (.25 hours2.893519e-4 days <br />0.00694 hours <br />4.133598e-5 weeks <br />9.5125e-6 months <br /> x 1,500 forms).

The estimated annual cost to respond to the information requested is

$22,500(375 hours0.00434 days <br />0.104 hours <br />6.200397e-4 weeks <br />1.426875e-4 months <br /> x $60/ hour).

,.I.,..

14'. Re'asons for Change in Bur' den Reduced recruiting effort by NRC commensurate with a reductioniin the.

FTE ceiling has reduced-the number of anticipated ' responses from 2,000 to -1,500 per year with a corresponding reduction in burden.

15. Publication for Statistical Use Information' gathered is:not published.

B.

COLLECTION OF INFORMATION EMPLOYING STATISTICAL METHODS

' Statistical methods are'not used in this information collection.

I

Enclosure:

Sample NRC Form 212 l

i i

f g

w = _-- - - - - _ - - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

NRCPo.w 212 U.S. NUCLEAR REGULATORY COMMISSION DATE H4H h-tC APPROVED dY OMI n so.oon N CM em-qng

""""""*i '"'

QUALIFICATIONS INVESTIGATION The applicent named below hos applied for a position in the NRC. Please rete the applicent against the items below in rsspect to the period of tlrne you either supervised or vare acquainted with the opplicent, include any comments you may feel are relevent. Please return the completed form to rne by the return date indicet:d above, sealed in the enclosed envelope end rnerked for Addressee Only.

APPLIC ANT'S N AME TO:

{

]

POSITION APPLIED POR FROM:

PERSONNEL STAFFING SPECIAUST L

j OFFICE OF PERSONNEL U.S. NUCLEAR REGULATORY COMMISSION WASHINGTON, DC 20655 This form is used for investigate

@lifications of external condidates for appointment, items 22,23, and us 5 U

3 88 24 rney be used by the Personnel aM%nelalMyst when edgig.el Ip#are required. The candidate should

> e<

sm 3<

j E

o e

m not be rated on those items which have been lined out by the a

Anotyst as not applicable.

I f

E O

1. TECHNICAL COMPETENCE.

2. EFFECTIVENESS IN MAKING DECISIONS OR RECOMMENDATIONS.

3. ABILITY TO COMPREHEND PROBLEMS,

4. EXTENT TO WHICH EMPLOYEE KEEPS ABREAST OF NEW DEVELOPMENTS.

5. EFFECTIVE USE OF EQUIPMENT, MATERI ALS AND TECHNIQUES RELATE D TO WORK.

6. THOROUGHNESS AND OBJECTIVITY IN CARRYING OUT WORK.

7. ABILITY TO IDENTIFY PRIORITIES AND ORGANIZE WORK.

8. ABILITY TO MEET DE ADLINES.

9. ABILITY TO SUPERVISE.

10. ABILITY TO ESTABLISH EFFECTIVE WORK RELATIONSHIPS WITH:

a. SUBOR DIN ATES.

b. CO-WOR KE RS.

e.HIGHE R LEVEL OFFICIALS.

d. REPRESENTATIVES OF INDUSTRY OR OTHER GOVERNMENT AGENCIES.

11. ORAL EXPRESSION.

12. WRITTEN EXPRESSION.

13. ADAPTABILITY.

14. EFFECTIVENESS IN TRAINING AND DEVELOPING SUBORDINATES.

15. DE PEN D ABILITY.

16. QUALITY OF WORK.

17. INITI ATIVE.

18. CRE ATIVITY.

19. AMOUNT OF WORK PRODUCED.

20. ABILITY TO WORK EFFECTIVELY IN STRESSFUL SITUATIONS.

21svuim runa ?:.=:M '.' .2K.

W3 // /N ')

22.

23.

24.

25. HOW WOULD YOU RATE APPLICANT IN REGARD TO POTENTIAL FOR FILLING JOB FOR WHICH APPLIED 7 26.WOULD YOU REHIRE THIS CANDIDATEr O YES O NO ADDITION AL COMMENTS (r/ ease cont /nue on reverse)

NOTE: Consistent with the Prlvecy Act of 1974, this evolustion may be revealed to the applicant upon his or her request. tiowever, if you request, your identity and other identifying information will be kept confidential. Please Indicate below whether you desire your identity to be kept confidential.

O MY IDENTITY MAY BE REVEALED.

O I nEQUEST MY IDENTITY BE KEPT CONFf DENTIAL.

DATE SiON ATURE

+

i. ADDITIONAL COMMENTS (Continued).

l k

i l

l.

l t

l

,I.

} l'

~

~

PRIVACY ACT STATEMENT

~

. Pursuant to 5 U.S.C. 552(e)(3), enacted into law by Section 3 of the Privacy Act of 1974 (Public Law 93479), the following statement is furnished tp individuals who supply information to the Nuclear Regulatory Commission on NRC Forms 212 and 212A. This information is maintained in systems of records designated es NRC-1, NRC 11, and NRC 28 and described at 40 Federal Reg 1 ster 45333,45337, and 45344, respectively (October 1,1975).

1. ' AUTHORITY. Section 161(d) of the Atomic Energy Act of 1954, as amended (42 U.S.C. 2201(d));and 5 U.S.C.1302.

' 2. PRINCIPAL PURPOSE (S).llnformation entered.on this form is used to determine quefifications and suitability of applicants for employment with the NRC. The completed form may be used to examine, rete, end/or essess the prospective empi,oyee's quellfications.

L 3. ' ROUTINE USES. None.

' 4. WHETHER DISCLOSURE l$ MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVIDING INFORMATION.

Completion of the form by all other individuals is voluntary; however, failure to supply the requested Information may result in the Individual not receiving full consideration for the potential job.

C Ed - L..Frencn or unisi, esourm and Empiuyn.n. Fe.

5, SYSTEM MANAG S) AND ADDRESS. Chief to ng 4 C i,.. 7.J_- M Personnel, Office et9ibmkiewedea, U.S. Nuclear Reguletory Commission, Washington,

%f

- * = - "N

. 20555.