Information Collection

NPPD Visitor Request Form

IC 229537 under ICR 201712-1670-003 · OMB 1670-0036.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1670-0036 can be found here:

Documents and Forms

Document Name Document Type
Form 11000-39 NPPD Visitor Request Form Form and Instruction
11000-39 NPPD Visitor Request Form DHS Form 11000-39 - updated 4-27-17.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NPPD Visitor Request Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	11000-39	NPPD Visitor Request Form	DHS Form 11000-39 - updated 4-27-17.pdf		Yes	Yes	Fillable Fileable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records
Title: DHS/ALL-023	FR Citation: 75 FR 8088

Number of Respondents: 20,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20,000	20,000
Annual IC Time Burden (Hours)	3,333	3,333
Annual IC Cost Burden (Dollars)	0	0

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.