OMB control number

Contractor Fitness/Security Screening Request Form

OMB 1601-0039 · DHS/OS.

OMB 1601-0039

This collection of information is necessary to initiate the contractor fitness screening process for determining whether a person (i.e., the respondent) who has been invited to perform work under a contract for, or on behalf of the Department of Homeland Security (DHS), should be deemed fit to perform such work and eligible for logical and/or physical access to DHS resources based on the risk levels of the designated position. The respondent is responsible for providing and/or verifying information to complete Section II of DHS Form 11000-25; the remaining sections of DHS Form 11000-25 (Sections I, III, and IV) are completed by DHS federal employees

The latest form for Contractor Fitness/Security Screening Request Form expires 2027-04-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
privacy_pia_dhswide_isms-2011.pdf Supplementary Document
1600-0004 Contractor Fitness Security Screening SORN 85 FR 64511 11-12-2020.pdf Supplementary Document
30 Day FRN 88 FR 73038 10-24-2023.pdf Supplementary Document
60-Day FRN 88 FR 55469 8-15-2023.pdf Supplementary Document
Homeland Security Presidential Directive 12.pdf Supplementary Document
FAR 52.204-9.pdf Supplementary Document
FAR 52.204-2.pdf Supplementary Document
Executive Order 13764.pdf Supplementary Document
Executive Order 13467.pdf Supplementary Document
Executive Order 10577.pdf Supplementary Document
Executive Order 9397.pdf Supplementary Document
5 CFR Part 732.pdf Supplementary Document
5 CFR Part 731.pdf Supplementary Document
1601-NEW Contractor Fitness Security Screening Request Form SS_A (DHS Form 11000-25).docx Supporting Statement A
Contractor Fitness/Security Screening Request Form DHS Form 11000-25

All Historical Document Collections

202311-1601-001

Approved without change

New collection (Request for a new OMB Control Number)

2023-11-15