ML20249A574

Request for OMB Review & Supporting Statement Re Qualifications Investigation.Estimated Respondent Burden 350 H

ML20249A574
Person / Time
Issue date:	06/09/1998
From:	Shelton B NRC OFFICE OF INFORMATION RESOURCES MANAGEMENT (IRM)
To:
Shared Package
ML20249A244	List: ML20249A243 ML20249A574 ML20249A578
References
OMB-3150-0033, OMB-3150-33, NUDOCS 9806170089
Download: ML20249A574 (6)

Text

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5 PAPERWORK REDUCTION ACT SUBMISSION e

Please read the instructions before completing this form. For additional forms or assistance in completing this form, contact your agency's Paperwork Clearance Officer. Send two copies of this form, the collection inr+wment to be reviewed, the Supporting Statement, and any additional documentation to: Office of information and Regulatory Affairs, Office of Management and Budget, Docket Library, Room 10102,72517th Street NW, Washington, DC 20503

1. Agency / Subagency originating request

2. OMB control number U.S. Nuclear Regulatory Commission X

a.

3150-0033

b. None

3. Type of information collection / check oncJ

4. Type of review requested (check one)

a. New collection Y

a. Regular submission

c. Delegated

b. Revision of a currently approved collection

b. Emergency - Approval requested by (date):

5. Will this information collection have a

,, ye,

c. Extension of a currently approved collection significant economic impact on a

d. Reinstatement, without change, of a previously approved substantial number of small entities?

X b.No collection for which approval has expired

e. Reinstatement, with change, of a previously approved X

a. Three years from approval date collection for which appcoval has expired Requested

~~

expiration date

f. Existing collection in use without an OMB control number

7. Title NRC Form 212, Qualifications investigation B. Agency form number (s) (if applicable)

NRC Form 212

9. Keywords Qualifications, employment, investigation, human resources, appointment, hiring

10. Abstract Information requested on NRC Form 212 is used to determine the qualifications and suitability of external apphcants for employment in professional positions with the NRC. The completed form is used by Human Resource Staffing Specialists of the Office of Human Resources to examine, rate and/or assess the prospective employee's qualifications.

11 Atfected pubiec IMark primary with "P" and an erhers ther apply warh *x*I

12. obhgation to respons (Ma:i pnmary with 'P' nod ser others that apply warh x*)

P

a. Individuals or households

d. Farms P

a. voluntary

b. Busmess or other for-profit

e. Federal Government

b. Required to obtain or ratain benefits

c. Not for-profit institutions

f. state, Local, or Tnbal Government

c. Man:iatory

13. Annual reporting and recordkeeping hour burden

14. Annual reporting and recordkeeping cost burden tin recusands of dollarsi

s. Number of respondents 1400

e. Total annualized capital /startup costs 0

b. Total r,nual responses 1400

b. Total annual costs to&M) 0

c. Total annualized cost requested O

1. Percentage of these responses

d. Current OMB Inventory 0

conecteo electronically 0

c. Total annual hours requested 350 8 Difference o

d. Current oMB inventory 350

f. Explanation of difference

1. Prograin chnpe nn

v. c

.c.

e. Difference 2.

{j g {; g p,g j

f. Explanation of difference n.

' ~' '

1. Program change a

2. Adjustment

15. Purpose of information collection

16. Frequency of recordkeeping or reporting (Check s// ther apply)

(Mart primary with *P' and all others that awly with 'X*)

a. Recordkeeping

b. Third-party d!sclosure T

c. Reporting Y

a. Application for benefits

e. Program planning or management

b. Program evaluation

f. Research x

1. on occasion

2. We=tkly

~~"~l 3. fAonthly

~

c. General purpose c*atistics

g. Regulatory or compliance

4. Quarterly

5. semi-annually

6. Annually

{

sL

8. other (describe)

d. Audit

7. BenniaHy I

5. statistical methods

18. Agency contact toerson who can best answer questions regarding the content of this submission)

/

I Does this inf ormation collection e,mploy statistical methods?

g

f.,

Nams i i O Janice M. Clemens, OHR Yes No 301-415-1534 iu-Phone.

. a 9806170089 980609 h d J-hp 2 95 PDR ORG EUSOMB p, {

PDR

SUPPORTING STATEMENT For NRC Form 212, " Qualifications investigation" (OMB Clearance No. 3150-0033)

Extension Request Description of information Collection This form is used for investigating the qualifications of external candidates for appointment to professional positions in the Nuclear Regulatory Commission (NRC). This extension package reflects no change in the number of forms projected to be received by the NRC and no change in burden for the next three-year clearance period.

A.

JUSTIFICATION

\\

1.

Need for and Practical Utility of the Collection of Information I

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 Human Resources, in conjunction with other information in the NRC files, to determine the qualifications of the applicant i

for appointment to the position under consideration.

2.

Aaency Use of Information The 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 Human Resources in determining the qualifications of applicants for employment.

3.

Reduction of Burden Throuah Information Technoloav 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 l

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

4.

Effort to !dentify Duplication and Use of Similar Information Where the NRC has recent references on file and the positions which the applicant applied for are similar, no additional references are requested. The l

r L

2

' Information Requirements Control Automated System (IRCAS) was searched, and no duplication was found.

5.

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 fullinvestigation.

6.

Consequences to Fadaral Prooram or Poliev Activities if the Cch*.n is Nqt g,

Conducted or is Condudad Less Frean_=ntiv This information has to be collected and reviewed prior to malhng a decision on employment eligibility.

7.-

Circumstances Which Justifv Variation from OMB Guid=ll ass

. This request does not vary from OMB guidelines.

8.

Consultations OntalA4 the NRC An opportunity to comment on the NRC Form 212 information collection requirements was published in the Federal Register on January 30,1998 (63 FR 4675). No comments were received.

9.

Pavment of Gift to Raanondents Not applicable.

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 Ona=tions Not applicable.

12.

Estimated Burden and Burden Hour Cost i

Past experience indicates tnat responding on this form takes about 15 minutes.

The total estimated time to respond to the approximately 1400 forms used annually is 350 hours0.00405 days <br />0.0972 hours <br />5.787037e-4 weeks <br />1.33175e-4 months <br /> (.25 hours2.893519e-4 days <br />0.00694 hours <br />4.133598e-5 weeks <br />9.5125e-6 months <br /> x 1400 forms). The estimated annual cost to respond to the information requested is $43,750 (350 hours0.00405 days <br />0.0972 hours <br />5.787037e-4 weeks <br />1.33175e-4 months <br /> x $125/ hours).

l-

l c

i 3

13.

Estimated of Other Additional Cosis Not applicable.

14.

Estimated Annualized Cost to the Federal Government The total estimated annual cost to the Federal Govemment for printing, handling, reviewing, and assessing the NRC Form 212 is $43,750 (350 hours0.00405 days <br />0.0972 hours <br />5.787037e-4 weeks <br />1.33175e-4 months <br /> x $125/ hour).

This cost is fully recovered through fee assessments to NRC licensees pursuant to 10 CFR Parts 170 and 171.

15.

Reasons for Chance in Burden or Cost There has been no change in burden.

16.

Publication for Statistical Use Information gathered is not published.

17.

Reason for Not Disolavino the Exoiration Date The expiration date is displayed on form.

18.

Exceotions to the Certification Statement Not applicable.

B.

COLLECTION OF INFORMATION EMPLOYING STATISTICAL METHODS Not applicable.

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NR6 FORM 212 U.S. NUCLEAR REGULATORY COMMISSION APPROVED 0,Y OMB: NO. 3150-0033 EXPIRES: MM/DD/YYYY l

(MM-TYYD

, NRCMO 101 Esnmated burden per response to comply with this vrmuntwy mformaton coHechon request 16 mmutes This mformanon es used to determme the qualificanons and suitatniity of extemas appist. ants for employment Forward comments regardmg burden estimate to the Records Management Branen (T-6 F33). U S Nuclear Regula QUALIFICATIONS INVESTIGATION 2mmxot and io ine P.-i, Reouction Pro,ect <3, tory Commiswan. Washmgton, DC so4c33>. Oieice c, Management and Budget. Washmgton. DC 20$o3 If an informabon collection does not display a currently vahd OMB control number, the NRC may not conduct or sponsor and a person is not required to respond to, the mformation collection The applicant named below has applied for a position in the NRC. Please rate the applicant against the DATE Items below in respect to the penod of time you either supervised or were acquainted with the applicant.

Include any comrnents you.sy feel are relevant. Please retum the completed form to the Human RETURNB W Resources Staffing Specialist listed in the "FROM" block by the return date indicated, sealed in the enclosed envelope and marked For Addressee Only.

NAME OF APPUCANT TO:

]

rosmON FOR WHICH APPUED FROM.

HUMAN RESOURCES STAFFING SPECIALIST OFFICE OF HUMAN RESOURCES l

l U.S. NUCLEAR REGULATORY COheAISSION L-_

_.._J WASHINGTON, DC 20555 0001 tu al tu v)

This form is used for investigating the qualifications of external cand dates for appointment. The candidate should O

ji 0 0

30 G

not be rated on those items which have been lined out by the Human Resources Staffing Specialist as not E OI 5 9I applicable. Addit: anal comments can be provided on the reverse side.

1. TECHNICAL COMPETENCE.

l

2. EFFECTIVENESS IN MAKING DECISIONS OR RECOMMENDATIONS.

I

3. ABILITY TO COMPREHEND PROBLEMS.

4.

EXTENT TO WHICH EMPLOYEE KEEPS ABREAST OF NEW DEVELOPMENTS.

5.

EFFECTIVE USE OF EQUIPMENT, MATERIALS, AND TECHNIQUES RELATED TO WORK.

6. THOROUGHNESS AND OBJECTIVITY IN CARRYING OUT WORK.

7. ABILITY TO IDENTIFY PRIORITIES AND ORGANIZE WORK.

8. ABILITY TO MEET DEADLINES.

9. ABILITY TO SUPERVISE.

10. ABILITY TO ESTABLISH EFFECTIVE WORK RELATIONSHIPS WITH:

a.

SUBORDINATES.

b.

CO-WORKERS.

c.

HIGHER LEVEL OFFICIALS.

d.

REPRESENTATIVES OF INDUSTRY OR OTHER GOVE.RNMENT AGENCIES.

11. ORAL EXPRESSION.

12. WRITTEN EXPRESSION.

13. ADAPTABILITY.

14. EFFECTIVENESS IN TRAINING AND DEVELOPING SUBORDINATES.

15. DEPENDABILITY / RELIABILITY.

16. QUALITY OF WORK.

17. INITIATIVE.

18. CREATIVITY.

19. AMOUNT OF WORK PRODUCED.

20. ABILITY TO WORK EFFECTIVELY IN STRESSFUL SITUATIONS.

21. WORK HABITS.

{

22. HOW WOULD YOU RATE APPUCANT IN REGARD TO POTENTIAL FOR FILUNG POSmON FOR WHICH APPUED7

}

23, HAVE YCU ANY REASON TO QUESTION THIS PERSON'S TRUSTWORTHNES) CR LOYALTY TO THE UNrrED STATES OF AMERICA 7 YES thplam)

NO

24. DO YOU KNOW OF ANY PERSONAL HABITS AND/OR CHARACTERISTICS THAT WOULD MWE TPts PERSON UNSUITABLE FOR EMPLOYMENT BY THE U.S. GJVERNMENT?

f

25. WOULD YOU REHIRE THIS CAh'DIDATE? Of app # cable. cirt.f one)

YES NO NM RELATIONSHIP TO APPLICANTTELIP5b.SOR[ lCO-WORKER 7 PROFESSIONAL l lOTHf5Cooctfy)

~

26.

o ivar-Act of 1974, this evaluation may t4 evassed to the applicant upon hra or er requenit. Howiwer. if vou reyN1, your identity and other NOTE: consisted are the r

ident;fying inbrmistion wdi be kept confidential. Please indicate bonruf vActher you desire W id vith he Irept conndentual.

O MY IDENTITY MAY BE REVEALED.

C 1 REQUEST MY IDE..TITY BC KEF'f CON /IDEuTIAL

$1GNA1L5t7 f.A rE NRC FORM 212 (MM-YYYY) r RIN'ED ON hlCYCLED PAPER The foim vnes desgr ed usmg informs

_