Information Collection

Technical Assistance (TA) Evaluation Form - 9042

IC 197202 under ICR 201902-1670-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 DHS Form 9042 Technical Assistance (TA) Evaluation Form - 9042 Form and Instruction
DHS Form 9042 Technical Assistance (TA) Evaluation Form DHS Form 9042.pdf www.dhs.gov/ictapscip-resources. Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Technical Assistance (TA) Evaluation Form - 9042	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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 and Instruction	DHS Form 9042	Technical Assistance (TA) Evaluation Form	DHS Form 9042.pdf	https://www.dhs.gov/ictapscip-resources.	Yes	Yes	Fillable Fileable

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 71659

Number of Respondents: 128	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 75 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	128	-1,872	2,000
Annual IC Time Burden (Hours)	11	-829	840
Annual IC Cost Burden (Dollars)	0	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.