Information Collection

Application for Transfer of SAFETY Act Designtation

IC 190453 under ICR 201001-1640-003 · OMB 1640-0001.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1640-0001 can be found here:

Documents and Forms

Document Name Document Type
Form DHS Form 10001 Application for Transfer of SAFETY Act Designtation Form and Instruction
DHS Form 10001 Application for Transfer of SAFETY Act Designtation 10001_Application_for_Transfer_of_SAFETY_Act_Designation.pdf www.safetyact.gov Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Transfer of SAFETY Act Designtation	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	DHS Form 10001	Application for Transfer of SAFETY Act Designtation	10001_Application_for_Transfer_of_SAFETY_Act_Designation.pdf	www.safetyact.gov	Yes	Yes	Fillable Fileable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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