Information Collection

Contractor Fitness/Security Screening Request Form DHS Form 11000-25

IC 263396 under ICR 202311-1601-001 · OMB 1601-0039.

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IC Title:	Contractor Fitness/Security Screening Request Form DHS Form 11000-25	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 5 CFR 731 5 CFR 732

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: General Government

Subfunction: Central Personnel

Privacy Act System of Records
Title: DHS/ALL-023 Department of Homeland Personnel Security Management.	FR Citation: 85 FR 64511

Number of Respondents: 45,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	45,000	45,000
Annual IC Time Burden (Hours)	11,250	11,250
Annual IC Cost Burden (Dollars)	0	0

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