This personnel vetting form will be used by HHS in conducting personnel vetting investigations for persons under consideration for, or retention in low risk, public trust, or national security positions as defined in 5 CFR 731 and 5 CFR 1400, as well as for individuals requiring eligibility for access to classified information under Executive Order 12968, as amended.
This form will also be used by HHS in determining whether an individual performing work for, or on behalf of, the U.S. Government under a contract should be deemed fit to perform the duties and eligible for logical or physical access when duties to be performed by an employee of a contractor are equivalent to the duties performed by an employee in a low risk position, a public trust position or when the nature of the work to be performed is sensitive and could bring about an adverse effect on national security.
This form may also be used for making ongoing trust determinations for suitability or fitness for Federal employment, fitness for contract employment, eligibility for access to classified information or to hold a sensitive position, or eligibility for physical and
logical access to federally controlled facilities or information systems.
EO: EO 12968 Name/Subject of EO: Access to Classified Information
Sherette Funn-Coleman
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
25,000
0
0
25,000
0
0
Annual Time Burden (Hours)
61,048
0
0
61,048
0
0
Annual Cost Burden (Dollars)
1,343,611
0
0
1,343,611
0
0
Yes
Miscellaneous Actions
No
There is no burden decrease or reduction action this is a request to use a new form