An Information Collection Request (ICR) is a federal agency's request for approval from the Office of Management and Budget (OMB) to collect information from the public.
Under the Paperwork Reduction Act (PRA), agencies must justify why the information is needed and how it will be used.
Federal agencies are required to submit an ICR whenever they create, renew, or modify an information collection. Each ICR includes a description of the collection,
supporting materials and documentation (such as forms, surveys, or scripts), and proof that the agency has met the requirements of the PRA.
The ICR is submitted to the The Office of Information and Regulatory Affairs (OIRA) within OMB for review and approval. OIRA grants approval for a maximum of three years, after
which the collection must be renewed through a new ICR submission.
ICRs are publicly available on RegInfo.gov, and additional guidance can be found in the FAQs.
Note: Presidential Action influences are notated for ICRs received between January 20, 2025 and July 19, 2025.
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| 202108-0960-002 | Important Information About Your Appeal, Waiver Rights and Repayment Options | SSA | 2022-01-13 | Active | Revision of a currently approved collection
Important Information About Your Appeal, Waiver Rights and Repayment Options
Key Information
Abstract
This collection is a voluntary, one-time collection, for the respondents to let SSA know that they want to request a lower rate of benefit withholding, installment payments, an explanation of the overpayment, an appeal, or a waiver. Respondents can complete the form and return it to an SSA office, or they may also contact SSA via telephone or via an in-office visit. The respondent is not required to complete this form; however, they may complete this form alone or with help. The respondents are individuals who are overpaid Social Security payments. |
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| 202201-3240-001 | Request for a Medical Exception to the COVID-19 Vaccination Requirement | SSS | 2022-01-13 | Active | New collection (Request for a new OMB Control Number)
Request for a Medical Exception to the COVID-19 Vaccination Requirement
Key Information
Abstract
Consistent with Executive Order 14043, of September 9, 2021, “Requiring Coronavirus Disease 2019 Vaccination for Federal Employees, and included within the Safer Federal Workforce Task Force Guidance mandating all Federal employees be vaccinated by November 22, 2021, the Selective Service System (SSS) has established specific safety protocols for individuals fully vaccinated and not fully vaccinated against coronavirus disease 2019 (COVID-19). Individuals who are not fully vaccinated against COVID-19 by November 22, 2021, or who choose not to provide this information will be required to comply with applicable OMB, OPM and SSS guidance for individuals not fully vaccinated against COVID-19, including wearing masks regardless of the transmission rate in a given area, physical distancing, regular screening testing, and adhering to applicable travel requirements. SSS employees may request an exemption on the basis of a medical condition or circumstance. Exemptions will be granted in limited circumstances and only where legally required. The Medical Exception Form will be provided directly to the individuals who are requesting a medical exemption.Emergency Justfication:SSS is seeking approval of the form, “Request for a Medical Exception Form to the COVID-19 Vaccination Requirement,” which will be completed by employees who seek a medical exemption. SSS seeks OMB’s approval to process the form as emergency clearance requests in accordance with 5 C.F.R. § 1320.13, Emergency Processing. The Form will be used by SSS staff and provided to employees to ensure they submit adequate information to support the exemption request. This form will also ensure the information collected is consistent among the components and minimize the need to seek additional evidence. Rendered decisions should be in accordance with guidelines established by the Safer Federal Workforce Task Force Guidance. |
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| 202112-0960-004 | Request for Reinstatement (Title II) | SSA | 2022-01-12 | Active | Revision of a currently approved collection
Request for Reinstatement (Title II)
Key Information
Abstract
SSA allows certain previously entitled disability beneficiaries to request expedited reinstatement (EXR) of benefits under Title II of the Social Security Act when their medical condition no longer permits them to perform substantial gainful activity. SSA uses Form SSA-371 to obtain: (1) A signed statement from individuals requesting an EXR of their Title II disability benefits, and (2) proof the requestors meet the EXR requirements. SSA maintains the form in the disability folder of the applicant to demonstrate the requestors’ awareness of the EXR requirements, and their choice to request EXR. Respondents are applicants for EXR of Title II disability benefits. |
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| 202112-1660-001 | Threat and Hazard Identification and Risk Assessment (THIRA) and Stakeholder Preparedness Review (SPR) Unified Reporting Tool | DHS/FEMA | 2022-01-12 | Active | Revision of a currently approved collection
Threat and Hazard Identification and Risk Assessment (THIRA) and Stakeholder Preparedness Review (SPR) Unified Reporting Tool
Key Information
Abstract
The assessment is structured by the 32 core capabilities from the 2015 National Preparedness Goal. States, territories, urban areas, and tribes provide information on capability targets, their current capability levels and capability gaps for each core capability. Respondent States, Tribes, territories, and urban areas gather the information and complete the THIRA and SPR following the “Comprehensive Preparedness Guide (CPG) 201, Third Edition.” |
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| 202108-0960-001 | Site Review Questionnaires for Volume and Fee-for-Service Payees and Beneficiary Interview Form | SSA | 2022-01-12 | Active | Revision of a currently approved collection
Site Review Questionnaires for Volume and Fee-for-Service Payees and Beneficiary Interview Form
Key Information
Authorizing Statutes
Abstract
SSA uses the SSA-637, Site Review Questionnaire for Volume and Fee-for-Service Payees, to obtain information from payees about how the organization operates and carries out its representative payee responsibilities, including how it manages beneficiary funds. We then use the SSA-639, Beneficiary Interview Form, to obtain information from the beneficiaries to help corroborate the payee's statements. Due to the sensitivity of the information, SSA employees always complete the forms based on the answers respondents give during the interview. This collection is mandatory for representative payees and voluntary for beneficiaries. SSA will not allow representative payees who do not respond to continue serving as representative payees. The respondents are individuals; State and local governments; non-profit and for profit organizations serving as representative payees; and the beneficiaries they serve. |
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| 202111-0575-008CF | SF LLL Disclosure of Lobbying Activity | USDA/RHS | 2022-01-12 | Active | RCF New
SF LLL Disclosure of Lobbying Activity
Key Information
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| 202111-0575-004CF | SF-424A Budget Information Non-Construction Programs | USDA/RHS | 2022-01-12 | Active | RCF New
SF-424A Budget Information Non-Construction Programs
Key Information
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| 202111-0575-005CF | SF 424B Assurances - Non Construction Programs | USDA/RHS | 2022-01-12 | Active | RCF New
SF 424B Assurances - Non Construction Programs
Key Information
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| 202112-0570-002CF | Budget Information - Non-Construction Programs - Form SF 424A | USDA/RBS | 2022-01-12 | Active | RCF New
Budget Information - Non-Construction Programs - Form SF 424A
Key Information
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| 202112-0570-004CF | Disclosure of Lobbying Activities - Form SF LLL | USDA/RBS | 2022-01-12 | Active | RCF New
Disclosure of Lobbying Activities - Form SF LLL
Key Information
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| 202201-3064-001 | Joint Standards for Assessing Diversity Policies and Practices | FDIC | 2022-01-12 | Active | No material or nonsubstantive change to a currently approved collection
Joint Standards for Assessing Diversity Policies and Practices
Key Information
Abstract
Section 342 of the Dodd-Frank Wall Street Reform and Consumer Protection Act of 2010 (Act) required the OCC, Fed, FDIC, CFPB, and SEC each to establish an Office of Minority and Women Inclusion (OMWI) to be responsible for all matters of the Agency relating to diversity in management, employment, and business activities. The Act also instructed each OMWI Director to develop standards for assessing the diversity policies and practices of entities regulated by the Agency. The Agencies worked together to develop joint standards (Joint Standards) and, on June 10, 2015, they jointly published in the Federal Register the “Final Interagency Policy Statement Establishing Joint Standards for Assessing the Diversity Policies and Practices of Entities Regulated by the Agencies” (Policy Statement). The Policy Statement includes Joint Standards that cover “Practices to Promote Transparency of Organizational Diversity and Inclusion.” These Joint Standards contemplate that a regulated entity is transparent about its diversity and inclusion activities by making certain information available to the public annually on its Web sites or through other appropriate communications methods, in a manner reflective of the entity’s size and other characteristics. The specific information referenced in these standards is (a) the entity’s diversity and inclusion strategic plan; (b) its policy on its commitment to diversity and inclusion; (c) its progress toward achieving diversity and inclusion in its workforce and procurement activities; and (d) opportunities available at the entity that promote diversity. In addition, the Policy Statement includes Joint Standards that address “Entities’ Self-Assessment.” The Joint Standards for Entities’ Self-Assessment envision that a regulated entity, in a manner reflective of its size and other characteristics, (a) conducts annually a voluntary self-assessment of its diversity policies and practices; (b) monitors and evaluates its performance under its diversity policies and practices on an ongoing basis; (c) provides information pertaining to its self-assessment to the OMWI Director of its primary federal financial regulator; and (d) publishes information pertaining to its efforts with respect to the Joint Standards. |
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| 202201-2137-004 | Public Awareness Program | DOT/PHMSA | 2022-01-11 | Active | Revision of a currently approved collection
Public Awareness Program
Key Information
Abstract
This information collection request would require pipeline operators to develop and implement public awareness programs. The public awareness programs should establish communications and provide information necessary to enhance public understanding of how pipelines function and the public's role in promoting pipeline safety. This mandatory, annual reporting and record keeping collection requires operators to submit their completed programs to PHMSA or, in the case of an intrastate pipeline facility operator, the appropriate State agency. The operator's program documentation and evaluation results must also be available for periodic review by appropriate regulatory agencies. This information will be used by PHMSA to evaluate compliance with pipeline safety regulations. The purpose of the collection is to prevent the risks caused by unintentional pipeline releases and their impact on the public and the environment. |
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| 202201-2137-002 | Qualification of Pipeline Safety Training | DOT/PHMSA | 2022-01-11 | Active | Revision of a currently approved collection
Qualification of Pipeline Safety Training
Key Information
Abstract
49 CFR Part 192 Subpart N and Part 195 SubPart G require all individuals who operate and maintain pipeline facilities to be qualified and keep records of qualification. The purpose of this mandatory information collection request is to ensure compliance with the record keeping requirements prescribed in the federal pipeline safety regulations. Pipeline operators must make and maintain the records as described and have those records available for compliance inspection by PHMSA staff upon request. Examples of such records include the identification of qualified individuals; identification of covered tasks; dates of current qualification; and qualification methods. Records supporting an individual's current qualification shall be maintained while the individual is performing the covered task. Records of prior qualification and records of individuals no longer performing covered tasks shall be retained for a period of five years. |
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| 202201-2137-001 | Hazardous Liquid Pipeline Assessment Requirements | DOT/PHMSA | 2022-01-11 | Active | Revision of a currently approved collection
Hazardous Liquid Pipeline Assessment Requirements
Key Information
Abstract
Operators of Hazardous Liquid Pipelines are required to document the continual assessment and evaluation of their pipelines' integrity through inspection or testing, as well as remedial preventive, and mitigative actions. In cases where a determination about pipeline threats has not been obtained within 180 days following the date of inspection, pipeline operators must notify PHMSA in writing and provide an expected date when adequate information will become available. Operators must also notify PHMSA if they are unable to assess their pipeline via an in-line inspection. Operators who choose to use an alternate assessment method must demonstrate that their pipeline is not capable of accommodating an in-line inspection tool and that the use of an alternative assessment method will provide a substantially equivalent understanding of the condition of the pipeline. This mandatory record keeping requirement supports the U.S. Department of Transportation’s “SAFETY STRATEGIC GOAL” which targets three main strategic initiatives: managing risk and integrity, sharing responsibility, and providing effective stewardship. This goal enhances public health and safety by working toward the elimination of transportation-related deaths and injuries. This information is used by PHMSA to determine compliance with federal pipeline safety regulations and is also used by Agency and State Officials to assist federal and state pipeline safety inspectors who audit this information when they conduct compliance inspections and to provide background for failure investigations. |
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| 202112-2130-002 | Railroad Signal System Requirements | DOT/FRA | 2022-01-11 | Active | Extension without change of a currently approved collection
Railroad Signal System Requirements
Key Information
Abstract
The information collected under 49 CFR parts 233, 235, and 236 is used by FRA to monitor railroad compliance with FRA’s inspection and testing requirements for signal systems, as well as to review and approve railroad requests to discontinue or materially modify existing signal systems. The information collected is also used by FRA to monitor signal failures (e.g., failure of a signal appliance, device, method, or system to function or indicate as required by 49 CFR part 236 that results in a more favorable aspect than intended or other condition hazardous to the movement of a train). This collection of information is mandatory, collected as needed, and it involves both reporting and recordkeeping requirements. |
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| 202201-1652-002CF | Certification of Vaccination | DHS/TSA | 2022-01-10 | Active | RCF New
Certification of Vaccination
Key Information
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| 202108-1018-001 | Policy for Evaluation of Conservation Efforts When Making Listing Decisions (PECE) | DOI/FWS | 2022-01-10 | Active | Extension without change of a currently approved collection
Policy for Evaluation of Conservation Efforts When Making Listing Decisions (PECE)
Key Information
Abstract
The Policy for Evaluation of Conservation Efforts When Making Listing Decisions (PECE) provides criteria that the Fish and Wildlife Service uses to evaluate conservation efforts when making decisions on whether or not to list a species as endangered or threatened. |
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| 202111-1110-002 | National Incident-Based Reporting System (NIBRS) | DOJ/FBI | 2022-01-10 | Active | Revision of a currently approved collection
National Incident-Based Reporting System (NIBRS)
Key Information
Abstract
Under Title 28, United States Code (U.S.C.), Section (§) 534 and 34 U.S.C. § 41303, this collection requests incident-based data from law enforcement agencies in order for the FBI UCR Program to collect and disseminate NIBRS data. |
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| 202112-0990-004 | Family Planning Annual Report 2.0 | HHS/HHSDM | 2022-01-10 | Historical Active | Revision of a currently approved collection
Family Planning Annual Report 2.0
Key Information
Abstract
The Office of Population Affairs (OPA), within the Office of the Assistant Secretary for Health, seeks approval for a revision of the 3-year encounter level data collection for the Family Planning Annual Report (FPAR). This annual reporting requirement is for competitively awarded grants authorized and funded by the Title X Family Planning Program. Currently approved under 0990-0479, this revision is adding the collection of two new data elements, sexual orientation and gender identity. OPA does not expect the addition of these elements to substantially change the burden. |
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| 202201-0938-003 | Statement of Deficiencies and Plan of Correction (CMS-2567) | HHS/CMS | 2022-01-07 | Historical Active | Extension without change of a currently approved collection
Statement of Deficiencies and Plan of Correction (CMS-2567)
Key Information
Abstract
This Paperwork package provides information regarding the form used by the Medicare, Medicaid, and the Clinical Laboratory Improvement Amendments (CLIA) programs to document a health care facility's compliance or noncompliance (deficiencies) with regard to the Medicare/Medicaid Conditions of Participation and Coverage, the requirements for participation for Skilled Nursing Facilities and Nursing Facilities, and for certification under CLIA. This form becomes the evidentiary basis for CMS certification decisions (including termination or denial of participation), and the form of public disclosure. In December, 2020, Congress passed the Consolidated Appropriations Act, 2021 (CAA, 2021). Section 407 of CAA, 2021, amended Part A of Title XVIII of the Social Security Act (the Act) at section 1822 establishing hospice program survey and enforcement requirements. This amendment, in part, now requires the Accrediting Organizations (AOs) that accredit hospice programs to include the form CMS-2567 to document the findings of their hospice program surveys beginning on October 1, 2021. As of June 2021, there are three AOs with CMS-approved hospice accreditation programs: Accreditation Commission for Health Care, Inc. (ACHC), Community Health Accreditation Partner (CHAP), and The Joint Commission (TJC). These three AOs survey approximately half of the over 5,000 Medicare-certified hospice programs, while the SAs survey the remaining half. To enable AOs to use the form CMS-2567, we must revise it by adding a field for the AO name. Also, the instructions must be updated to include AOs as another group which utilizes the form CMS-2567. We have also included the COI/RIA burden calculations from CMS-1747-P related to the one-time update needed to each AO’s proprietary electronic systems in order to use the form CMS-2567 as directed by the CAA, 2021. |
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