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ICR SUPPORTING STATEMENT OUTLINE

Part A 

1. Identification of the Information Collection

1(a) Title of the Information Collection

Confidential Financial Disclosure Form for Special Government Employees Serving on Federal 

Advisory Committees at the U.S. Environmental Protection Agency (Renewal); EPA ICR No. 

2260.05, OMB Control No. 2090-0029

1(b) Short Characterization/Abstract

The purpose of this information collection request is to assist the United States Environmental 

Protection Agency (EPA or the Agency) in selecting federal advisory committee members who 

will be appointed as Special Government Employees (SGEs), mostly to EPA’s scientific and 

technical committees. To select SGE members as efficiently and cost effectively as possible, the 

Agency needs to evaluate potential conflicts of interest before a candidate is hired as an SGE and 

appointed as a member to a committee by EPA’s Administrator or Deputy Administrator. 

Agency officials developed the “Confidential Financial Disclosure Form for Special Government 

Employees Serving on Federal Advisory Committees at the U.S. Environmental Protection 

Agency,” also referred to as Form 3110-48, for a greater inclusion of information to discover any

potential conflicts of interest as recommended by the Government Accountability Office. 

2. Need for and use of the Collection

2(a) Need/Authority for the Collection

In June 2001, the Government Accountability Office (GAO) issued a report entitled “EPA’s 

Science Advisory Board Panels – Improved Policies and Procedures Needed to Ensure 

Independence and Balance.” GAO recommended that EPA develop policies and procedures that 

better identify and mitigate potential conflicts of interest and support the development of 

balanced panels. Recommendations included gathering the required conflict of interest 

information before a member is selected, specifically:

• Determine whether each panel will be reviewing a “particular matter” before selecting the 

panel in order to identify the financial conflict-of-interest requirements, if any, to which the 

panelists will be subject.

• Obtain and evaluate relevant background information on peer review panel candidates 

before appointing panel members. The evaluation should include explicitly discussing with 

potential panelists: (1) items not adequately reported on the confidential financial 
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disclosure form as well as items reported that could present conflicts of interest; (2) other 

information relevant to assessing impartiality, such as research conducted and previous 

public statements or positions on the matter being reviewed, interest of the employer or 

clients in the matter, participation in legal proceedings, work for chemical companies or 

other affected industries, and prior or current research grants that could be affected by the 

matter; and (3) whether they have any potential conflicts of interest related to the specific 

panel being established. Further, pertinent information obtained from discussions with 

panelists should be documented.” 

As part of that effort to respond to GAO’s recommendations, EPA developed a new and 

improved form for all of its scientific and technical committee’s Special Government 

Employees. 

EPA’s Designated Federal Officers (DFOs) who manage EPA federal advisory committees 

experienced great difficulty trying to use the OGE Form 450 to identify actual or potential 

conflicts of interest of potential candidates for Federal Advisory Committee membership. The 

OGE Form 450 was confusing for the proposed members and they did not identify all financial 

interests of possible concern. In response to the GAO’s recommendations, EPA developed the 

Form 3110-48 to ensure that all relevant financial interests are identified and considered during 

the member selection process. It is important for EPA to have this information collection in 

place because we continuously need to appoint new SGE members as new advisory committees 

are created or as members’ terms of appointment expire. 

The Form 3110-48 is completed by candidates for membership as SGEs on EPA federal advisory

committees. The form is completed as part of the member selection process and before they are 

invited to serve as a member of a federal advisory committee at EPA. The Form 3110-48 is 

reviewed by the Committee’s Designated Federal Officer, and the Program Office Deputy Ethics 

Official (DEO) to determine whether there is a financial conflict of interest between the proposed 

member’s public responsibilities and private interests/activities and whether there is any 

appearance of a lack of impartiality. In some cases, the Alternate Designated Agency Ethics 

Official also reviews the form. As GAO recommended, it is important to collect this information 

before the potential member is appointed to the advisory committee, because if a conflict of 

interest is identified after the person is appointed, the Agency may have to terminate the person’s 

membership and identify another person to serve on the committee. This is potentially

embarrassing to both the Agency and the appointed member. It is also important to know upfront 

that a candidate could serve if appointed, as the appointment process is time consuming and, as 

required by the Federal Advisory Committee Act, the Agency must ensure that the advisory

committee is balanced in the points of view represented. If a conflict is identified after a person 

is appointed to an advisory committee as an SGE, additional time is needed to select a 

replacement and the Agency loses valuable time and expertise in receiving the advice it needs. 

Also important is the fact that finding replacement members creates a burden of additional cost 

and staff hours. Using the Form 3110-48 benefits EPA by increasing efficiency and saving time 

and money. 
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Currently nine of EPA’s 21 federal advisory committees appoint members as SGEs and have a 

need to use the Form 3110-48. This number may increase as new committees are added, or 

decrease as committees are terminated. EPA anticipates averaging approximately 250 SGEs 

during the next 3 years.

2(b) Practical Utility/Users of the Data

Information gathered from Form 3110-48 will continuously help EPA to evaluate relevant 

background information on Special Government Employee candidates before appointing 

members. Using this form enables DFOs to expedite the process of selecting viable candidates 

for membership on EPA’s federal advisory committees. 

3. Non duplication, Consultations, and Other Collection Criteria3(a) Non duplication

Almost all information requested from respondents under this ICR is personal in nature, and in 

most cases, is not available from other sources.

3(b) Public Notice Required Prior to ICR submission to OMB

On June 24, 2014 (79 FR 35751) EPA sought comments on this ICR pursuant to 5 CFR 

1320.8(d). EPA has received no comments to date. A second comment period will be opened for

30 days once this ICR is submitted to OMB.

3(c) Consultations

In accordance with OMB’s Terms of Clearance on the previous approval of this ICR, EPA has 

reviewed the actual number of SGE confidential disclosure forms received over the last three 

years and consulted with various agency staff to determine trends in expected committee 

membership over the next three years. While committee membership can vary year to year, EPA 

anticipates that the number of SGEs completing the form during the period of this ICR will 

average 250 per year.

The below respondents were contacted for feedback on this ICR. They agreed that, on average, it 

takes approximately an hour to fill out the form. 

Edward Gbur, Jr., Ph.D.

University of Arkansas

Member of EPA’s Human Studies Review Board

egbur@uark.edu

Kyle L. Galbraith, Ph.D.

Carle Foundation Hospital

Member of EPA’s Human Studies Review Board 

kyle.galbraith@carle.com

Dr. James McManaman
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University of Colorado

Member of EPA’s Federal Insecticide, Fungicide, and Rodenticide Act Scientific Advisory Panel 

Jim.McManaman@ucdenver.edu

3(d) Effects of Less Frequent Collection

The form is required to be updated once a year. The form allows Government officials to 

determine whether there is a statutory conflict between Special Government Employees public 

responsibilities and private interests and activities, or the appearance of a lack of impartiality, as 

defined by federal regulation.

18 U.S.C. 208: “An employee is prohibited from participating personally and substantially in an 

official capacity in any particular matter in which, to his knowledge, he or any person whose 

interests are imputed to him under this statute has a financial interest, if the particular matter will 

have a direct and predictable effect on that interest.” 

5 C.F.R. 2635.502: Appearance of lack of impartiality: “Where an employee knows that a 

particular matter involving specific parties is likely to have a direct and predictable effect on the 

financial interest of a member of his household, or knows that a person with whom he has a 

covered relationship is or represents a party to such matter, and where the person determines that 

the circumstances would cause a reasonable person with knowledge of the relevant facts to 

question his impartiality in the matter, the employee should not participate in the matter unless 

he has informed the agency designee of the appearance of a problem and received authorization 

from the agency designee".

3(e) General Guidelines

This ICR complies with OMB’s general guidelines for the collection of information.

3(f) Confidentiality

Title I of the Ethics in Government Act of 1978 (the Act), 5 USC App., Executive Order 12674, 

and 5 CFR Part 2634, Subpart I, of the Office of Government Ethics regulations require the 

reporting of financial information that is relevant to the administration and application of the 

criminal financial conflict of interest laws, administrative standards of conduct, and agencyspecific statutory and program-related restrictions. The primary use of the information collected 

on this form is to allow EPA to conduct the conflicts reviews in accordance with applicable 

Federal laws and regulations. The information reported on the Form 3110-48 is “confidential” 

and required to be withheld from the public pursuant to Section 107(a) of the Act. Agency

personnel shall not publicly release the reports or the information contained therein except that 

disclosures may be pursuant to (1) a Federal, State or local law enforcement agency if the 

disclosing agency becomes aware of a violation or potential violation of law or regulation; (2) a 

court or party in a court or Federal administrative proceeding if the Government is a party or in 

order to comply with a judge-issued subpoena; (3) a source when necessary to obtain information 

relevant to a conflict of interest investigation or decision; (4) the National Archives and Records 
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Administration or the General Services Administration in records management inspections; (5) 

the Office of Management and Budget during legislative coordination on private relief 

legislation; and (6) in response to a request for discovery or for the appearance of a witness in a 

judicial or administrative proceeding, if the information is relevant to the subject matter. The 

confidential report will not be disclosed to any requesting person unless authorized by law.

EPA requires SGEs who are new to a federal advisory committee to complete parts 2-9 of Form 

3110-48 before participating in a Committee activity. Subsequently, SGEs must file reports 

annually to report on the previous calendar year. For these annual reports, the SGEs must 

complete parts 2-8. In addition, they must complete Part 1 (“Statement regarding any change 

since annual submission of the form”) and Part 9 (“Identification of any other information related 

to conflicts of interest or appearance of a lack of impartiality”) before participating in any new 

advisory activity. Filers must provide sufficient information about outside interests and activities 

so that EPA DFOs and ethics officials can make an informed judgment regarding any conflict of 

interest or appearance of lack of impartiality. EPA staff may contact proposed SGEs to obtain 

additional information if necessary to determine whether there is a conflict between an SGE’s 

public responsibilities and his/her or his/her spouse's private interests and activities.

3(g) Sensitive Questions

See response to 3(f).

4. The Respondents and the Information Requested

4(a) Respondents/SIC Codes

A Special Government Employee (SGE) is a person who is retained, designated, appointed, or 

employed to perform, with or without compensation, for a period not to exceed 130 days during 

any period of 365 consecutive days, temporary duties for the Federal Government either on a 

full-time or intermittent basis. SGEs who provide advice to EPA are required to file the Form 

3110-48 in lieu of the Office of Government Ethics Form 450 to disclose confidential financial 

information. Form 3110-48 has been reviewed and approved for use by the Office of 

Government Ethics. 

4(b) Information Requested

(i) Data items, including record keeping requirements

The Agency will maintain records of the Form 3110-48. Designated Federal Officers from 

Offices sponsoring federal advisory committees will retain files of the completed form. The 

Agency does not anticipate any record keeping activities on the part of the respondents under this 

ICR. 

(ii) Respondent Activities
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After being nominated by an outside party or themselves, respondents will be asked to 

Complete the Form 3110-48. Forms may be mailed or e-mailed to candidates. Although 

candidates may type their information on the form on-line, they must then print the form and 

sign it. They may return the form by mail, but may not return the form by e-mail as an original 

signature is required. Each form will involve reading instructions and completing the form. 

The form will require one hour to complete. Subsequent forms filed annually should take less 

time to complete as respondents gain familiarity with its information requirements and may only 

need to make slight changes to information filed previously.

5. The Information Collected–Agency Activities, Collection Methodology, and Information 

Management

5(a) Agency Activities

To respond to this ICR, we estimated the DFO spends one hour reviewing each Form 3110-48 

(sometimes calling and asking for further clarification or to address areas not filled out 

completely). The DFO labor cost is estimated to be a GS 14 Step 10, which is $66.19 per hour 

(rounded to $66 per hour) according to the Office of Personnel Management’s 2014 Salary Table

(http://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salarytables/14Tables/html/DCB_h.aspx). 

The EPA Deputy Ethics Official (DEO) labor cost is estimated to be a GS-15 Step 7, which in 

2014 was $71.87, rounded to $72 per hour at one hour per form. 

Both DFO and DEO total labor rates below include a factor of 1.6 (60%) for overhead costs.

DFO Cost

EPA estimates that approximately 250 advisory committee members will serve on EPA’s federal 

advisory committees as SGEs over the next 3 years. Multiplying the number of SGE members 

(250) by the 3 year average dollar amount paid to EPA’s DFOs ($66), and multiplying the 

subtotal cost of $16,500 by 1.6 (60% overhead) to allow for employee overhead costs, we 

estimate the subtotal to be $26,400. 

Year 1 @ $66 for 1 hour x 250 = $16,500 x 1.6 = $26,400

Year 2 @ $66 for 1 hour x 250 = $16,500 x 1.6 = $26,400

Year 3 @ $66 for 1 hour x 250 = $16,500 x 1.6 = $26,400

DEO Cost

Multiplying the number of SGE members (250) by the dollar amount paid to EPA’s DEO with a 

3 year average cost ($72), and multiplying the cost of $18,000 by 1.6 (60% overhead) to allow 

for employee overhead costs, we estimate the subtotal to be $28,800. 

Year 1 @ $72 for 1 hour x 250 = $18,000 x 1.6 = $28,800

Year 2 @ $72 for 1 hour x 250 = $18,000 x 1.6 = $28,800

Year 3 @ $72 for 1 hour x 250 = $18,000 x 1.6 = $28,800
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Total DFO and DEO Cost Using 3 Year Average

The total 3 year average dollar burden estimate for this ICR (for both DFOs and DEO) is 

approximately $55,200 each year.

DFO 3 year average $26,400 + DEO 3 year average $28,800 = $55,200

Agency (EPA) activities associated with the collection of information include:

Designated Federal Officers (DFOs) for each committee with Special Government Employees 

(SGEs), Deputy Ethics Official, Assistant Deputy Ethics Official:

• First internal EPA review and approval of Form 3110-48 (completed 2003)

• Second internal EPA review and approval of Form 3110-48 (completed 2007)

• Taking actions to review the form, ascertain improvements, and revise periodically

(approximately 3 year intervals or more if needed) 

Designated Federal Officers (DFOs) for each committee with Special Government Employees 

(SGEs):

• Providing copies of the mandatory form

• Answering any respondent questions, follow-up

• Gathering respondents completed forms

• Reviewing and analyzing data

• Recordkeeping/storing completed form

• Forwarding form to EPA’s Ethics staff for review and analyzing

Deputy Ethics Official:

• First review and approval of Form 3110-48 (completed 2003)

• Second review and approval of Form 3110-48 (completed 2007)

5(b) Collection Methodology and Management

In collecting and analyzing the information associated with this ICR, EPA will use a telephone 

system, personal computers, e-mail and websites from which the respondents can obtain blank 

forms, as well as using the mail and committee meetings for distribution of the form. Although 

candidates (respondents) may type their information on the form on-line, they must then print the 

form and sign it. They may return the form by mail, but may not return the form by e-mail as an 

original signature is required. 

Although EPA uses internet websites and e-mail to distribute the blank forms, this form is not a 

survey instrument, and no database is necessary to aggregate results.

This information is not available to the public.

5(c) Small Entity Flexibility

Not applicable.
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5(d) Collection Schedule

• After being nominated by an outside party or themselves, respondents are asked to 

Complete the Form 3110-48 (No schedule – dates are variable). 

• After the initial completion of the Form 3110-48, respondents are asked to update the 

form annually (generally during January of each year). Respondent’s confidential 

financial information is not made public.

6. Estimating The Burden and Cost of the Collection

6(a) Estimating Respondent Burden

To respond to this ICR, we estimated that each responding SGE candidate will take one hour to 

complete the Form 3110-48. We anticipate that EPA will pay an estimated labor cost of $55, 

which including the standard overhead factor of 1.6 produces a loaded wage rate of $88. We 

estimate that approximately 250 SGE advisory committee members will have to respond to this 

request each year. Multiplying the estimated number of SGE members (250) by the dollar 

amounts to be paid to EPA’s SGEs each successive year, and multiplying the subtotal costs of 

each successive year by 1.6 to allow for respondent overhead costs, we estimate that the total 

dollar burden estimate for this ICR to be approximately $22,000 for year 1, $22,000 for year 2 

and $22,000 for year 3. The grand total for all 3 years is estimated at $66,000. The annual 

average respondent cost over the three years is $22,000, as indicated in the following annual 

respondent burden and cost table.

6(b) Estimating Respondent Costs

(i) Estimating Labor Costs

Annual Cost for SGE Respondents 

SGE Respondent 

Activities to Complete Form 

3110-48

Burden Hours/

Respondent

Burden for SGE 

Candidate

($55 per labor hour 

multiplied by 1.6 for 

overhead equals 

$88)

Number of 

Respondents per 

Year

Total

Cost per 

Year

Total per Year 60 minutes 

(1 hour/100%)

$88 250 $22,000

 Read Instructions 10 minutes

(~0.17%)

(0.17 x $88 =) 

$14.96

($14.96 x 250 =) $3,740

 Fill Out Form 48 minutes

(~0.80%

(0.80 x $88 =)

$70.40

($70.40 x 250 =) $17,600

 Prepare Envelope to Mail 2 minutes

(~0.03%)

(0.03 x $88 =)

$2.64

($2.64 x 250 =) $660
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TOTAL 60 minutes $88 250 $22,000

(ii) Estimating Capital and Operations and Maintenance Costs

Not applicable.

(iii) Capital/Start-up Operating and Maintenance (O&M) Costs

Not applicable.

(iv) Annualizing Capital Costs

Not applicable.

6(c) Estimating Agency Burden and Cost

Annual Agency Burden and Cost

Agency

Hours 

Number 

of Hours 

Per Year

Labor Cost 

Per Year

Overhead Cost 

Per Year

Subtotal Labor 

& Overhead 

Cost 

Total

Cost/

Year

(rounded)

Form 3110-48

DFO Activities

For 250

Respondents

$66 per hour 

Distribute form to 

SGE Nominees 

(respondents) and 

answer their 

questions

5 minutes

(0.0833)

250 $1,374 $825 $2,199

Review and 

analyze data of 

completed form, 

and ask follow-up 

questions

45 minutes

(0.75)

250 $12,375 $7,425 $19,800

Recordkeeping/

storing form 

5 minutes

(0.0833)

250 $1,374 $825 $2,199

Forward form to 

EPA Ethics Staff

5 minutes

(0.0833

250 $1,374 $825 $2,199

 DFO Subtotal 60 min./1 hour

(1.00)

250 $16,497 $9,900 $26,397 $26,400

DEO Activities 

For 250

Respondents

$72 per hour 

Review, analyze, 

follow-up, and 

approve or 

60 min./1 hour

(1.00)

250 $18,000 $10,800 $28,800
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disapprove

 DEO Subtotal 60 min./1 hour

(1.00)

250 $18,000 $10,800 $28,800 $28,800

EPA Grand Total

(DFO & DEO)

120 min./ 2 hours

2.00

500 $34,497 $20,698 $55,195 $55,200

6(d) Estimating the Respondent Universe and Total Burden and Costs

See 6(a) and (b).

6(e) Bottom Line Burden Hours and Cost Tables

(i) Respondent Tally

Bottom-Line Annual Burden and Cost for SGE Respondents 

SGE Respondent 

Activities to Complete 

Form 3110-48

Burden Hours/

Respondent

Burden for SGE 

Candidate

($55 per labor hour 

multiplied by 1.6 for 

overhead equals $88)

Number of 

Respondents per 

Year

Total

Cost per 

Year

Total per Year

60 minutes 

(1 hour/100%)

$88 250 $22,000

(ii) The Agency Tally

Bottom-Line Annual Agency Burden and Cost

Agency

Hours For Each 

Review

Number 

of Hours 

Per Year

Labor 

Cost Per 

Year

Overhead 

Cost Per 

Year

Total 

Agency

Cost per 

Year

Agency Total

(DFO &DEO) 

For 250

Respondents

120 min./ 2 hours

2.00

500 $34,500 $20,700 $55,200

(iii) Variations in the Annual Bottom Line

We do not anticipate major variations in the annual bottom line burden hours and costs for the 

respondents or the Agency.

6(f) Reasons for Change in Burden
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There is a decrease of 50 hours in the total estimated respondent burden compared with the ICR 

currently approved by OMB. This change is due to a decrease in the estimated number of 

respondents from 300 to 250.

6(g) Burden Statement

The annual public reporting and recordkeeping burden for this collection of information is 

estimated to average one hour per response. Burden means the total time, effort, or financial 

resources expended by persons to generate, maintain, retain, or disclose or provide information 

to or for a Federal agency. This includes the time needed to review instructions; develop, 

acquire, install, and utilize technology and systems for the purposes of collecting, validating, and 

verifying information, processing and maintaining information, and disclosing and providing 

information; adjust the existing ways to comply with any previously applicable instructions and 

requirements; train personnel to be able to respond to a collection of information; search data 

sources; complete and review the collection of information; and transmit or otherwise disclose 

the information. An agency may not conduct or sponsor, and a person is not required to respond 

to, a collection of information unless it displays a currently valid OMB control number. The 

OMB control numbers for EPA's regulations are listed in 40 CFR part 9 and 48 CFR chapter 15. 

To comment on the Agency's need for this information, the accuracy of the provided burden 

estimates, and any suggested methods for minimizing respondent burden, including the use of 

automated collection techniques, EPA has established a public docket for this ICR under Docket 

ID Number EPA-HQ-OA-2010-0757, which is available for online viewing at 

www.regulations.gov, or in person viewing at the Office of Environmental Information Docket 

in the EPA Docket Center (EPA/DC), EPA West, Room 3334, 1301 Constitution Avenue, NW, 

Washington, D.C. The EPA Docket Center Public Reading Room is open from 8:30 a.m. to 4:30 

p.m., Monday through Friday, excluding legal holidays. The telephone number for the Reading 

Room is (202) 566-1744, and the telephone number for the Office of Environmental Information 

Docket is (202) 566-9744. An electronic version of the public docket is available at 

www.regulations.gov. This site can be used to submit or view public comments, access the 

index listing of the contents of the public docket, and to access those documents in the public 

docket that are available electronically. When in the system, select “search,” then key in the 

Docket ID Number identified above. Also, you can send comments to the Office of Information 

and Regulatory Affairs, Office of Management and Budget, 725 17th Street, NW, Washington, 

D.C. 20503, Attention: Desk Officer for EPA. Please include the EPA Docket ID Number EPAHQ-OA-2010-0757 and OMB Control No. 2090-0029 in any correspondence.