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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Security
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
DOE F 5631.34
Data Report on Spouse Cohabitant
DOE F 5631 34 Data Report on Spouse Cohabitant 10-2021.pdf
Yes
Yes
Fillable Fileable Signable
Form and Instruction
DOE F 5631.5
The Conduct of Personnel Security Interviews
DOE F 5631.5 The Conduct of Personnel Security Interviews 10-2021.pdf
Yes
Yes
Fillable Fileable Signable
Form and Instruction
DOE F 5631.18
Security Acknowledgement
DOE F 5631.18 Security Acknowledgement 10-2021.pdf
Yes
Yes
Fillable Fileable Signable
Form
DOE F 5631.20
Request for Visit or Access Approval
DOE F 5631.20 Request for Visit or Access Approval 10-2021.pdf
Yes
Yes
Fillable Fileable Signable
Form
DOE F 5639.3
Report of Security Incident/Infraction
DOE F 5639.3 Report of Security Incident - Infraction 10-2021.pdf
Yes
Yes
Fillable Fileable Signable
Other-FACTS Screenshot
FACTS Screen Shots.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
DOE F 473.2
Badge Request Electronic
DOE F 473.2 Badge Request Electronic 10-2021.pdf
Yes
Yes
Fillable Fileable
Form
DOE F 472.3
Foreign Citizenship Acknowledgement
DOE F 472.3 Foreign Citizenship Acknowledgement 10-2021.pdf
Yes
Yes
Fillable Fileable Signable
Form and Instruction
DOE F 471.1
Security Incident Notification Report
DOE F 471.1 Security Incident Notification Report 10-2021.pdf
Yes
Yes
Fillable Fileable
Form
DOE F 5631.29
Security Termination Statement
DOE F 5631.29 Security Termination Statement 10-2021.pdf
Yes
Yes
Fillable Fileable Signable
Form
Standard Form 328
Certificate Pertaining to Foreign Interests
OMB 1910-1800 SF-328.pdf
Yes
Yes
Fillable Fileable Signable
Form and Instruction
DOE F 473.3
Clearance Access Request
DOE F 473.3 Clearance Access Request.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
International Affairs and Commerce
Subfunction:
Foreign Affairs
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
75,661
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
83 %
Approved
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
84,621
0
0
-2,272
0
86,893
Annual IC Time Burden (Hours)
13,251
0
0
1,955
0
11,296
Annual IC Cost Burden (Dollars)
1,192,590
0
0
-145,800
0
1,338,390
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.