PERSONNEL SECURITY QUESTIONNAIRE (INDUSTRIAL) (MULTI- PURPOSE)

ICR 197712-0704-007

OMB: 0704-0002

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0704-0002 197712-0704-007
Historical Active 197711-0704-009
DOD/DODDEP
PERSONNEL SECURITY QUESTIONNAIRE (INDUSTRIAL) (MULTI- PURPOSE)
No material or nonsubstantive change to a currently approved collection   No
Emergency 12/06/1977
Approved with change 12/06/1977
Retrieve Notice of Action (NOA) 12/06/1977
  Inventory as of this Action Requested Previously Approved
12/31/1982 12/31/1982 12/31/1982
50,000 0 50,000
100,000 0 100,000
0 0 0

APPLICATION USED TO OBTAIN EXTENSIVE PERSONAL HISTORY INFORMATION TO DETERMINE ELIGIBILITY OF CONTRACTOR EMPLOYEE FOR TOP SECRET CLEARANCE AND OTHER SPECIAL ACCESS AUTHORIZATIONS.

None
None


No

1
IC Title Form No. Form Name
PERSONNEL SECURITY QUESTIONNAIRE (INDUSTRIAL) (MULTI- PURPOSE) DD FORM 49

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 50,000 50,000 0 0 0 0
Annual Time Burden (Hours) 100,000 100,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
12/06/1977


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