View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 0704-0542	ICR Reference No: 202111-0704-001
Status: Historical Active	Previous ICR Reference No: 201809-0704-002
Agency/Subagency: DOW/DODDEP	Agency Tracking No:
Title: Personnel Security System Access Request Form
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/31/2022
	Date Received in OIRA: 12/30/2021
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2025	36 Months From Approved	01/31/2022
Responses	22,225	0	22,225
Time Burden (Hours)	3,704	0	3,704
Cost Burden (Dollars)	134,646	0	120,385

Authorizing Statute(s): EO: EO 10450 Name/Subject of EO: Security Requirements for Government Employment
   US Code: 50 USC 435 Name of Law: Purposes
   EO: EO 10865 Name/Subject of EO: Safeguarding Classified Information Within Industry
   EO: EO 12333 Name/Subject of EO: United States Intelligence Activities
   EO: EO 12829 Name/Subject of EO: National Industrial Security Program
   US Code: 50 USC 401 Name of Law: Congressional Declaration of purpose
   EO: EO 12968 Name/Subject of EO: Access to Classified Information

Citations for New Statutory Requirements: None

Annual Cost to Federal Government: $125,136

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Stepheny Fanning 571 305-6685 stepheny.l.fanning.civ@mail.mil

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