View Information Collection (IC)

View Information Collection (IC)

IC Title:	CFATS Personnel Surety Background Check Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 6 CFR 27

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	11000-29	Background Check to Identify Terrorist Ties for an Affected Individual at a High Risk Chemical Facility	CFATS Personnel Surety Background Check Form (04 20 11) v1.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records
Title: DHS/NPPD-002 CFATS Personnel Surety Prorgram System of Records	FR Citation: 76 FR 34732

Number of Respondents: 1,303,700	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	1,303,700	0	1,303,700	0	0	0
Annual IC Time Burden (Hours)	703,998	0	703,998	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
CFATS PS Instrument Scope	CFATS PS Instrument Scope (04-20-11) - CLEAN.doc	05/03/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.