Instructions for completion of the Data Element/New Request
Agency Version
SECTION 1
Item 1, Agency – Indicate the agency requesting this change. (Spell out agency names - do not use only
acronyms).
Item 2, Date – Date the form is filled out. Enter MM/DD/YYYY.
Item 3, Name and Title- Indicate the person and their title. Please note, this person may be contacted if
additional information is required.
Item 4, Origin of the request (SSC) – Indicate ‘Yes’ if this request is originating for a Shared Service Center
(SSC). Indicate ‘NO’ if it is not coming from a SSC.
Item 5, Which SSC – If the answer to item 4 is ‘Yes’, indicate which SSC is making the request.
Item 6, Discussions with other SSCs – Respond with either ‘Yes’, ‘No’ or ‘N/A’.
Item 7, Response from SSCs – If the response to item 6 is ‘Yes’, then list each SSA and your perception of their
position with this request.
Item 8, Location – Indicate the location of the office making the request, please include suite numbers and/or
floors.
Items 9, 10 and 11 – Indicate City, State and ZIP Code.
Item 12, Phone number – Indicate the Point of Contact’s (POC) phone number.
Item 13, e-mail address – Indicate the POC’s e–mail address.
Data Element
Item 14, What data is needs to be captured? – Provide specific information on the type of data.
Item 15, What is the purpose for the data collection? – Provide in-depth information on the purpose of the
data collection (for example, using the data for workforce analysis).
Item 16, Legal authority or justification – Indicate legal authority, if non exists indicate n/a
Item 17, Additional Information – Provide any additional information that you believe would be helpful in
assessing this request.
SECTION 2
Section 2 should be filled out ONLY at the request of the Center for Workforce Information &
Systems Requirements (CWISR). This may occur after the review of the information in Section 1.
Item 20, Does this information already exist? – If you are not sure if it is currently being collected please
indicate n/a.
ITEM 21, What is the timeline associated with this request? – Indicate when you would like to have this
request completed.
Item 22, List any consideration the team should be aware of as they review this request- Include any
information you may have on the internal or external impact of this request.
Item 22, To what EHRI feeds will this data be reported? - List all feeds you are aware of that may be
impacted.
Item 23, What is your initial collection strategy? – Include the current status.
Item 24, What is your maintenance strategy? – Remember to include how often and how you plan to
communicate.
Direct all comments and questions to: DataElementRequest@opm.gov
OPM 1828
April 2013
