Information Collection

State, Local, Tribal and Private Sector Clearance Request Form

IC 214622 under ICR 202304-1670-003 · OMB 1670-0013.

Documents and Forms

Document Name Document Type
Form DHS 9014 State, Local, Tribal and Private Sector Clearance Request Form Form and Instruction
DHS 9014 PRIVATE SECTOR CLEARANCE PROGRAM REQUEST 1670-0013_PSCP_DHS Form 9014_CISA_protected.pdf Form and Instruction
DHS 9014 PRIVATE SECTOR CLEARANCE PROGRAM REQUEST 1670-0013_PSCP_DHS Form 9014_CISA_protected.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State, Local, Tribal and Private Sector Clearance Request Form	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 9014	PRIVATE SECTOR CLEARANCE PROGRAM REQUEST	1670-0013_PSCP_DHS Form 9014_CISA_protected.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records
Title: Department of Homeland Security/ALL--023 Personnel Security Management System of Records	FR Citation: 75 FR 8088

Number of Respondents: 550	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	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	550	-110	660
Annual IC Time Burden (Hours)	92	-18	110
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.