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EDICS Tracking and OMB Number: (XXXX) 1820
- 0625 Revised: 05/01 /2014

**SUPPORTING STATEMENT FOR PAPERWORK REDUCTION ACT SUBMISSION** 
**A. Justification 1. Explain the circumstances that make the collection of information necessary. Identify**  **any legal or administrative requirements that necessitate the collection. Attach a**  **hard copy of the appropriate section of each statute and regulation mandating or authorizing the**  **collection of information ,**  **or you may**  **provide a valid URL**  **link or paste the applicable section**  **1 . Specify the review type of the collectio**  **n (new, revision, extension, reinstatement with change, reinstatement without change)**  **. If revised, briefly specify the changes. If a rulemaking is involved, make note of the sections or changed sections, if applicable.**  Section 509 of the Rehabilitation A ct of 1973 , as amended ( Rehabilitation A ct), established the Protection and Advocacy of Individual Rights (PAIR) program to support the protection and advocacy

(P&A) s ys tem in each State. The P&A s ys tem was created by the Developmental Disabilities Assis tance and Bill of Rights Act of 2000 (DD Act) (42 USC 6041 et seq.) to protect the legal and human rights of individuals with disabilities. Prior to the 1992 amendments to the Rehabilitation A ct , the P&A s ys tem was required to operate two programs: the P rotection and Advocacy for the Developmentally Disabled (PADD) program and the Protection and Advocacy for Individuals with Mental I llness (PAIMI ) program. Unfortunately , these programs were unable to meet the needs of man y people with disabilities due to narrowl y defined eligibility requirements. Congress funded the PAIR program with the 1992 amendments so that the PAIR program could advocate for those individuals with disabilities who were ineligible for advocacy services from the PADD and PAIMIprograms . PAIR also is authorized to serve those individuals with disabilities whose issues fall beyond the scope of services that the Client Assistance Program (CAP) can provide. PAIR, which is a required component of the P&A sy stem in each State, is administe red b y the Rehabilitation Services Administration (RSA) pursuant to the requirements of Section 509 of the Rehabilitation Act . Section 509(f) of the Rehabilitation Act sets forth the application requirements for the PAIR program. Most of these requirements mirror the requirements set forth in Part C of the DD act
. One of the application requirements is that the PAIR program sign a set of assurances that the PAIR can and will carry out its statutorily prescribed purposes and functions. This preprint, whi ch is being submitted for approval, contains the assurances to which the PAIR program must agree. These assurances are based on the following statutory and regulatory requirements:

1 Please limit pasted text to no longer than 3 paragraphs.2

EDICS Tracking and OMB Number: (XXXX) 1820
- 0625 Revised: 05/01 /2014
1) Title V, Section 509, of the Rehabilitation Act ; 2) Federal regulations at 34 CFR Part 381 implementing section 509 of the Rehabilitation Act ; 3) Part C of the DD Act, which sets forth all of the requirements for the P&A sy stem; and 4) General requirements for all written requests for assistance under the Education Department Genera l Administrative Regulations (34 CFR Part 76). **2. Indicate how, by whom, and for what purpose the information is to be used. Except for a new collection, indicate the actual use the agency has made of the information received**  **from the current collectio n.**  A signed set of assurances is a condition for receipt of Federal funds for the PAI R program. This requirement is mandated specifically for the PAIR program by section 509 of the Rehabilitation Act and its implementing regulations at 34 CFR Part 381 and for the P&A sy stem in general by

the DD Act and its implementing regulations. The assurances list all of the requirements that must be satisfied in order for the program to receive Federal funds under section 509 of the Rehabilitation Act
. RSA requir e d each P&A to submit the assurances and other materials only once, prior to fiscal year (FY) 2007, beginning October 1, 2006. These materials served as a request for FY 2007 funds, and for funding in all subsequent fiscal years, until such time as the Go vernor, in accordance with the provisions of the DD Act, may redesignate the P&A. This procedure reduces the reporting burden on the P&As and simplifies the process b y which grant awards are made b y RSA. This preprint, which is being submitted for appro val, is without revisions from the previous preprint approved b y OMB under number 1820

- 0625. This version of the PAIR assurances will exp ire on October 31, 2014
. **3. Describe whether, and to what extent, the collection of information involves the use of automated, electronic, mechanical, or other technological collection techniques or forms of**  **information technology, e.g. permitting electronic submission of responses, and the basis for the decision of adopting this means of collection. Also describe any**  **consideration given to using technology to reduce burden.**  This is a preprinted legal document, which requires authoritative signature and minimal reporting burden. PAIR programs are not allowed to submit an electronic version of this document because i t requires an authoritative signature. The possibility of allowing the grantees to submit the form electronicall y, with a hard cop y of the signature page, was considered. However, the assurances preprint consists of only a two - page document in which the grantee is only required to check each of the 10 boxes to assure compliance and sign the form. RSA deliberatel y made this preprint simple so that little effort is required on the part of the PAIR grantee. The burden on the grantee is so minimal that it d oes not justify allowing the grantee to submit the PAIR Assurances in two stages.3

EDICS Tracking and OMB Number: (XXXX) 1820
- 0625 Revised: 05/01 /2014 **4. Describe efforts to identify duplication. Show specifically why any similar information already available cannot be used or modified for use for the purposes described**  **in Item 2 above.**  This document collects unique information that is not collected under an y other instrument. In formation collected b y this set of assurances is required b y Federal Statute and is not obtained through an y other data source.
**5. If the co llection of information impacts small businesses or other small entities, describe**  **any methods used to minimize burden. A small entity may be (1) a small business which is deemed to be one that is independently owned and operated and that is not dominant i**  **n its field of operation; (2) a small organization that is any not**  **- for**  **- profit enterprise that is**  **independently owned and operated and is not dominant in its field; or (3) a small government jurisdiction, which is a government of a city, county, town, towns**  **hip, school district, or special district with a population of less than 50,000.**  The collection of this information does not involve small businesses or other small entities. **6. Describe the consequences to Federal program or policy activities if the c ollection is not**  **conducted or is conducted less frequently, as well as any technical or legal obstacles to reducing burden.**  As described above in answer to number two (2), the Federal regulations require the PAIR program to submit the application and sign ed assurances and other materials only once prior to October 1, 2006. These materials served as the request for FY 2007 funds and all subsequent fiscal ye ars, until such time as the PAIR program in the State may be re

designated. **7. Explain any special circumstances that would cause an information collection to be**  **conducted in a manner:**

 **requiring respondents to report information to the agency more often than quarterly;** 

 **requiring respondents to prepare a written response to a collection of information in**  **fewer than 30 days after receipt of it;**

 **requiring respondents to submit more than an original and two copies of any document;** 

 **requiring respondents to retain records, other than health, medical, government contract, grant**  **- in**  **- aid, or tax records for mo**  **re than three years;**

 **in connection with a statistical survey, that is not designed to produce valid and reliable results than can be generalized to the universe of study;** 4

EDICS Tracking and OMB Number: (XXXX) 1820
- 0625 Revised: 05/01 /2014

 **requiring the use of a statistical data classification that has not been reviewed a nd**  **approved by OMB;**

 **that includes a pledge of confidentiality that is not supported by authority established in statute or regulation, that is not supported by disclosure and data**  **security policies that are consistent with the pledge, or that unnecessaril y impedes**  **sharing of data with other agencies for compatible confidential use; or**

 **requiring respondents to submit proprietary trade secrets, or other confidential information unless the agency can demonstrate that it has instituted procedures to**  **protect t he information’s confidentiality to the extent permitted by law.**  There are no special circumstances that would require this information to be collected in a different manner. **8. As**  **applicable, state that the Department has published the 60 and 30 Federal R**  **egister notices as**  **required by 5 CFR 1320.8(d), soliciting comments on the information collection prior to submission to OMB. Summarize public comments received in**  **response to that notice and describe actions taken by the agency in response to these comme**  **nts. Specifically address comments received on cost and hour burden. Describe efforts to consult with persons outside the agency to obtain their views on the**  **availability of data, frequency of collection, the clarity of instruction and record keeping, di**  **sclosure, or reporting format (if any), and on the data elements to be recorded, disclosed, or reported.**  **Consultation with representatives of those from whom information is to be obtained or those who must compile records should occur at least once every**  **3 years**

**– even if the**  **collection of information activity is the same as in prior periods. There may be circumstances that may preclude consultation in a specific situation. These**  **circumstances should be explained.** These assurances are taken directl y fro m Federal law and regulations; therefore, public comment has not been sought. Consultation was sought from the PAI R grantees and the National Disability

Rights Network (NDRN), formerly known as the National Association of Protection and Advocacy Sy stems (NAPAS), when the regulations governing the PAIR program, which prescribe these assurances, were published. Furthermore, the PAI R grantees and NDRN had opportunities to comment on the statutory requirements governing the PAIR program during the most recent reauthorization process for the Rehabilitation Act
. **9. Explain any decision to provide any payment or gift to respondents, other than**  **remuneration of contractors or grantees with meaningful justification**  **.** There is no pay

ment or gift to respondents.5

EDICS Tracking and OMB Number: (XXXX) 1820
- 0625 Revised: 05/01 /2014
**1 0. Describe any assurance of confidentiality provided to respondents and the basis for the**  **assurance in statute, regulation, or agency policy. If personally identifiable information (PII) is being collected, a Privacy Act statement should be included on th**  **e instrument. Please provide a citation for the Systems of Record Notice and the date a Privacy Impact**  **Assessment was completed as indicated on the IC Data Form**  **. A confidentiality statement with a legal citation that authorizes the**  **pledge of**  **confidentialit y**  **should be provided. 2**  **If the collection is subject to the Privacy Act, the Privacy Act statement is deemed sufficient with**  **respect to confidentiality. If there is no expectation of confidentiality, simply state that the Department make**  **s no pledge about th**  **e confidentially of the data.** The written request does not contain specific or personal information. **11. Provide additional justification for any questions of a sensitive nature, such as sexual behavior and attitudes, religious beliefs, and other matter**  **s that are commonly considered private. The justification should include the reasons why the agency considers the**  **questions necessary, the specific uses to be made of the information, the explanation to be given to persons from whom the information is req**  **uested, and any steps to be taken to obtain their consent.**  The written request does not contain an y questions of a sensitive nature.
**12. Provide estimates of the hour burden of the collection of information. The statement**  **should:**

 **Indicate the number of respondents by affected public type (federal government,**  **individuals or households, private sector**

**– businesses or other for**  **- profit, private**  **sector**

**– not**  **- for**  **- profit institutions, farms, state, local or tribal governments),**  **frequency of response, annual ho ur burden, and an explanation of how the**  **burden was estimated, including identification of burden type: recordkeeping, reporting or third party disclosure. All narrative should be included in item 12.**  **Unless directed to do so, agencies should not conduct special surveys to obtain**  **information on which to base hour burden estimates. Consultation with a sample (fewer than 10) of potential respondents is desirable. If the hour burden**  **on respondents is expected to vary widely because of differences in activit y, size,**  **or complexity, show the range of estimated hour burden, and explain the reasons for the variance. Generally, estimates should not include burden hours for**  **customary and usual business practices.**

2 Requests for this information are in accordance with the following ED and OMB policies: Privacy Act of 1974, OMB Circular A

- 108

– Priv acy Act Implementation

– Guidelines and Responsibilities, OMB Circular A

- 130 Appendix I

– Federal Agency Resp onsibilities for Maintaining Records About Individuals, OMB M

- 03
- 22

– OMB Guidance for Implementing the Privacy Provisions of the E

- Government Act of 2002, OMB M
- 06
- 15

– Safeguarding Personally Identifiable Information, OM:6

- 104

– Privacy Act of 1974 (Coll ection, Use and Protection of Personally Identifiable Information)6

EDICS Tracking and OMB Number: (XXXX) 1820
- 0625 Revised: 05/01 /2014

 **If this request for approval covers more than one form, provide separate hour**  **burden estimates for each form and aggregate the hour burdens in the ROCIS**  **IC Burden Analysis Table. (The table should at**  **minimum include Respondent**  **types, IC activity, Respondent and Responses, Hours/Response, and Total Hours)** 

 **Provide estimates of annualized cost to respondents of the hour burdens for collections of information, identifying and using appropriate wage rate**  **categories. The cost of contracting out or paying outside parties for information collection activities s**  **hould not be included here. Instead, this cost should be included in Item 14.** 
Annual Burden Number of respondents 57 Frequency

of response 1 Total annual responses 57 Hours per response 0.16* Total hours 9 .1 Cost per hour $20 Total cost $182 .00 * The burden hours associated with the written request for a PAIR program grant is estimated at 10 minutes, or .16 hours, per P&A in each S tate or territory . The estimated hour burden per P&A is not expected to vary significantly . Estimated burden hours are founded on judgments based on submittals of similar written requests for P&A grants admini stered b y RSA, including the PAAT program and CAP. **13. Provide an estimate of the total annual cost burden to respondents or record keepers**  **resulting from the collection of information. (Do not include the cost of any hour burden**  **shown in Items 12 and 14.)**

 **The cost estimate should be split into two components: (a) a total capital and start**   ** up cost component (annualized over its expected useful life); and** **(b) a total operation and maintenance and purchase of services component. The estimates**  **should take into account costs associated with generating, maintaining, and disclosing or providing the information. Include descriptions of methods used to**  **estimate major cost factors including system and technology acquisition, expected**  **useful life of capital equipment, the discount rate(s), and the time period over which costs will be incurred. Capital and start**  **- up costs include, among other items,**  **preparations for collecting information such as purchasing computers and software;**  **monitoring, sampling, drilling and testing equipment; and acquiring and maintaining record storage facilities.** 

 **If cost estimates are expected to vary widely, agencies should present ranges of cost**  **burdens and explain the reasons for the variance. The cost of contracting out**7

EDICS Tracking and OMB Number: (XXXX) 1820
- 0625 Revised: 05/01 /2014 **information collection services should be a part of this cost burden estimate. In developing cost burden estimates, agencies may consult with a sample of**  **respondents ( fewer than 10), utilize the 60**  **- day pre**  **- OMB submission public**  **comment process and use existing economic or regulatory impact analysis associated with the rulemaking containing the information collection, as appropriate.** 

 **Generally, estimates should not incl ude purchases of equipment or services, or**  **portions thereof, made: (1) prior to October 1, 1995, (2) to achieve regulatory compliance with requirements not associated with the information collection, (3) for**  **reasons other than to provide information or kee p records for the**  **government or (4)**  **as part of customary and usual business or private practices. Also, these estimates**  **should not include the hourly costs (i.e., the monetization of the hours) captured above in Item 12**  Total Annualized Capital/Startup C ost : N/A Total Annual Costs (O&M) : N/A

____________________ T otal Annualized Costs Requested : N/A There is no additional c ost burden to the P&As in each S tate and territory when submitting the written assurances for a PAAT grant. **14. Provide estimates of annualized cost to the Federal government. Also, provide a**  **description of the method used to estimate cost, whic h should include quantification**  **of hours, operational expenses (suc**  **h as equipment, overhead, printing, and support staff), and any other expense that would not have been incurred without this collection of**  **information. Agencies also may aggregate cost estimates from Items 12, 13, and 14 in a single table.** 
a. Review of each written request .16 hours b. Number of written requests to review 57 c. Total time to review written requests 9 .1 hours* d. Federal hourl y rate of salary $ 49 e. Total cost (c x d) $ 446
* The estimated burden hours to the feder al government does not include time needed for negotiations when a written request is not approvable. Given the perfunctory

nature of this written request, it would be unusual for a request to not be approvable. **15. Explain the reasons for any program ch anges or adjustments. Generally, adjustments**  **in burden result from re -**  **estimating burden and/or from economic phenomenon outside of an agency’s control (e.g., correcting a burden estimate or an organic increase in the size of**  **the reporting universe). Progra m**  **changes result from a deliberate action that materially changes a collection of information and generally are result of new statute or an agency**  **action (e.g., changing a form, revising regulations, redefining the respondent universe, etc.).**8

EDICS Tracking and OMB Number: (XXXX) 1820
- 0625 Revised: 05/01 /2014 **Burden change s should be disaggregated by type of change (i.e., adjustment, program**  **change due to new statute, and/or program change due to agency discretion), type of collection (new, revision, extension, reinstatement with change, reinstatement without**  **change) and in clude**  **totals for changes in burden hours**  **, responses and cost**  **s (if applicable)**  **.** This submission requires no changes to the burden for hours and costs included in current OMB inventory , with the exception of updating the hourly wage for Federal employ ees ba sed on current information. **16. For collections of information whose results will be published, outline plans for**  **tabulation and publication. Address any complex analytical techniques that will be used. Provide the time schedule for the entire projec**  **t, including beginning and ending dates of the collection of information, completion of report, publication dates, and other actions.**  The information collected will not be published for statistical use. **17. If seeking approval to not display the expirat**  **ion date for OMB approval of the information collection, explain the reasons that display would be inappropriate.**  This document is not seeking OMB approval not to display the expiration date. **18. Explain each exception to the certification statement ide**  **ntified in the Certification of Paperwork Reduction Act.**  There are no exceptions to the certification statement. **B. Collection of I**  **nformation Employing Statistical Methods**  The written request for a PAIR grant is a legal document and does not require the use of an y statistical methods in obtaining information.