PROCEDURES FOR PREPARING AND SUBMITTING INFORMATION SYSTEMS DATA FORMS

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP81M00980R001600010004-0
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 6
• Document Creation Date: December 22, 2016
• Document Release Date: June 3, 2010
• Sequence Number: 4
• Publication Date: January 1, 2000
• Content Type: REGULATION

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FEDERAL INFORMATION SYSTEMS
PROCEDURES FOR PREPARING AND SUBMITTING
INFORMATION SYSTEMS DATA FORMS
The following material details instructions and proce-
dures for submitting Federal Information Systems inventory data
to GAO required by the Congressional Budget Act of 1974.
Agencies should submit a completed form on each major
information system as defined below; submissions should
be typed on Inventory of Federal Information Systems,
GAO Form 495. (See enclosed form). Major information sys-
tems include those which: 1) Fulfill an agency or organi-
zation's mission; 2) entail large expenditures; and 3) require
special management attention.
In classifying a system as major, consideration should
be given to the relative importance of its output to 1) sup-
porting agency heads in their policy decision-making process,
and 2) supporting agency or agency components heads in re-
sponding to external requirements for information such as the
President, Congress, GAO, CBO, OMB, and Treasury. Such cri-
teria as dollar resources, size, information content, purpose
(budget and programmatic), and scope shall be used to deter-
mine whether an agency's information system should be con-
sidered "major" as stipulated in this requirement. These
criteria shall be determined by the agency in cooperation
with the GAO inventory project staff. Agencies are requested
to review annually their total information capabilities,
including previous submissions.
Information System (Definition)
For the purpose of this inventory, an information system
is an organized collection and processing of data in accord-
ance with defined procedures (automated or manual). Examples
of information systems include:
--Management information systems
--Program management systems
--Planning and forecasting systems
--bibliographic data systems
--data base management systems
--models, simulations, and statistical systems
25 YEAR RE-REVIEW)
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In addition to any of the above type systems, all
agencies should make a submission of their budget/fiscal
information system. Direct completed forms and any ques-
tions or comments to:
Johnny R. Bowen
Program Analysis Division
U.S. General Accounting Office
441 G Street, N.W., Room 5008
Washington, D.C. 20548
Telephone: (202) 275-1837
Instructions for Completing GAO Form 495:
These instructions pertain to the completion of (1)
blank GAO Form 495's (2) partially completed GAO Form 495's,
and (3) a validation listing of previously reported system
information.
Completion of Blank GAO Form 495's (enclosure 1)
A blank GAO Form 495 (enclosure 1) should be completed
for each major information system that has not been previ-
ously submitted to GAO. Please provide all the information
requested on the form.
Completion of Partially Completed Form 495's (enclosure 2)
Enclosed are some partially completed GAO Form 495's
which are not currently contained in our Inventory of Fed-
eral Systems (enclosure 2). The partial information has been
identified by our staff through literature searches as pos-
sible candidates for inclusion in the inventory. We request
you evaluate these systems in light of the definition of a
major information system. Then if in agreement, complete the
remaining fields and return the form to GAO.
Validation of Previously Reported Information (enclosure 3)
Enclosure 3 contains a list of previously reported
information by your agency. Please review this information
for accuracy. Any changes, modifications, additions or
deletions of information should be penned neatly using capital
letters for ONLY those fields requiring a change.
The instructions for the completion of the inventory are
explained below. Each numbered item corresponds to the
numbered field on GAO Form 495, which is attached. Addi-
tional instructions and GAO Form 495's may be obtained from
the Program Analysis Division contact listed above.
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1. AGENCY: Identify the name of your Department or Agency
along with the bureau and major subordinate office which
is responsible for the system.
2. ACCESSION NUMBER: GAO USE ONLY.
3. AGENCY CONTROL NUMBER: Enter your agency's internally
assigned referencing number or code, if applicable.
4. TITLE: Enter the system name or identifying title,
include acronym if applicable.
5. AGENCY CONTACT: Identify the name and telephone number
of the person who can provide additional information
about the system.
6. CONTROL SPECIFICATIONS:
A. Submission status - Indicate whether submission
changes information previously submitted; is
new to the inventory; or deletes a previous
submission.
B. SYSTEM TYPE: Check whether the system is automated
or manual; unclassified or classified; also check
if it is a grant/financial assistance system.
C. DATE SYSTEM ESTABLISHED: Provide the year the sys-
tem was established and whether it is operational or
under development.
7. GEOGRAPHIC RELEVANCE: Indicate the levels of geographic
reference utilized when aggregating the data contained in
the system, i.e., national, state, county, city, congres-
sional district, standard metropolitan statistical area
(SMSA) or specify other level. Check one or more as
appropriate.
8. AVAILABILITY: Indicate whether the system output
(product) is publicly available through: the agency
contact, Government Printing Office (GPO); National
Technical Information Service (NTIS), or is restricted to
internal use only.
9. BUDGET REFERENCE: A) List the 11 digit OMB ID Code as
stated in the Appendix to the Budget of the United States
Government that is associated with the system B; identify
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the agency program(s)* or administrative activity and
corresponding code number. Please cite the applicable
domestic catalog number, if applicable, from the OMB
Catalog of Federal Domestic Assistance; C) Indicate
the related OMB Account Title(s) that are listed in
the Budget Appendix for each ID code number
10. AUTHORIZING LEGISLATION: Provide the statutory authority
Public Law number and section; Statutes at Large (Stat.);
U.S. Code citation and Public Law name for the program(s)
supported by this information system.
11. CONGRESSIONAL RELEVANCE: Leave this field blank.
12. CONTENT: Provide a summary of the information system
contents with emphasis on: purpose, principal subject
matter; data coverage; time reference; update cycle;
and major characteristics of the system.
13. INPUT: Identify the primary sources of information
(internal and external) that are included within the
information system. In addition, indicate the major
categories of input data.
14. OUTPUT: Describe the principal outputs of the infor-
mation system. List the categories of products generated
by the system. In addition, indicate the medium for
output: punched cards, machine readable form; hardcopy;
microfiche or CRT display.
NOTE: Please limit total abstract to 300 words (Items
12, 13 and 14).
15. REMARKS: This space may be used to provide additional
information about the information system.
*A program is an organized set of activities directed toward
a common purpose, objective, or goal undertaken or proposed
by an agency in order to carry out its legislated responsi-
bilities.
4
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 GAO FORM 495
(Rev. 2-79) INVENTORY OF FEL ERAL INFORMATION SYSTEMS
U.S. GENERAL ACCOUNTING OFFICE
PROGRAM ANALYSIS DIVISION
1. AGENCY
2. ACCESSION NUMBER (GAO use only)
Department of Health, Education and Welfare
S
Bureau Social Securit
Administration
y
N
Y
3.AGE
CONTROL NUMBER
C
(if applicable)
Office
4. TITLE (name and acronym)
5. NC CONTACT
a -oughl i n
Black Lung Payment System
Telephone - 301 594-4074
(area code) number)
6. CONTROL SPECIFICATIONS
A. Submission Status: ^ Change I New 11 Delete u
B. System Type: ? Automated ^ Manual ^ Unclassified ^ Classified " Grant/Financial Assistance
C. Date System Established Operational ykUnder Development
7. GEOGRAPHIC RELEVANCE
O International ? National ? State Ay ^ City
Congressional Other
El District ^ SMSA ^ (Specify) ^Non-applicable
8. AVAILABILITY (System outputs)
El Agency Contact ^ GPO Internal Use El Other
NT Onl
(Specify)
y
9. BUDGET REFERENCE
A. OMB ID Code(s)
B. Agency Program(s) (Domestic Assistance)
Catalog Number
C. OMB Account Title(s)
75-0409-0-1-601
Benefi 1 (13.806)
Special Benefits for Disabled
Coal Miners
10. AUTHORIZING LEGISLATION
L. Number Sec.
STAT
USC
P.L. Name
Federal Coal Mine Health and Safety
91 -1 3Sec. 401
83 STAT 792
30 use 901
Act, 1969
Federal Mine Safety and Health
95-1 64sec. 303 (a)
91 STAT1320
30 USC 951
Amendments Act of 1977
Sec.
STAT
USC
Sec.
STAT
USC
Sec.
STAT
USC
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ACCESSION NUMBER
11. CONGRESSIONAL RELEVANCE (GAO USE ONLY)
House Authorizing Committee House Approp ration Subcommittee
Code
12. CONTENT (purpose, scope, subsystems, time reference, update ie, file size)
The Coal Mine Payment System ablished shortly after enactment of
the Federal Coal Mine Health and Act to provide an electronic data pro-
cessing facility to maintain records reate a da?;-a base of management in-
formation.
The Black Lung Master .s consists of a pay(:ent master record and a
benefit master record wh' ched once a month. The payment master re-
cord.reflects the socia umber, the paymen identification code
under which black lung be re awarded, and various payment data. The
benefit master record contai a benefit record-for each beneficiary on the
account, including social security number, payment ad benefit identification
codes, payment st s, monthly benefit amount, benefciary's name, type of
benefit, date of ce, sex, offset information, credit information,
date of filing, titlement, representative ::ayee information and
statistical inform on.
13. INPUT (extern internal)
The data d in the data file for this system s derived from filing
applicati ft isabled miners and their associated employment records.
14. OUTPUT (major types, frequency, format)
The frequency of system output is monthly and includes the following:
Payment Master Record Computer File, Benefit Master Record Computer File,
Treasury Payment Tape File, Microfiche Files, Payme Reference Listing and
Benefit Reference Listing.
GAO USE ONLY
ANALYST
DATE
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