Information Collection

Office of Emergency Communications Technical Assistance (TA) Evaluation Form - 9042

IC 197202 under ICR 201104-1670-003 · OMB 1670-0023.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1670-0023 can be found here:

Documents and Forms

Document Name Document Type
Form 9042 Office of Emergency Communications Technical Assistance (TA) Evaluation Form - 9042 Form
9042 Office of Emergency communications Technical Assistance TA Evaluation - DHS Form 9042 v8 draft.pdf Form
DHS Form 9042_ PRA Statement.doc Privacy Act Statement IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Office of Emergency Communications Technical Assistance (TA) Evaluation Form - 9042	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	9042	Office of Emergency communications Technical Assistance (TA) Evaluation Form	TA Evaluation - DHS Form 9042 v8 draft.pdf		Yes	Yes	Fillable Printable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records
Title: Department of Homeland Security Mailing and Other Lists System of Records	FR Citation: 73 FR 228

Number of Respondents: 2,000	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	840	840
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Privacy Act Statement	DHS Form 9042_ PRA Statement.doc	04/08/2011

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