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pdfThe Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
571-227-3813, [email protected]
www.dhs.gov/privacy
Privacy Threshold Analysis
Version date: November 13, 2006
Page 1 of 5
PRIVACY THRESHOLD ANALYSIS (PTA)
This form is used to determine whether
a Privacy Impact Assessment is required.
Please use the attached form to determine whether a Privacy Impact Assessment (PIA) is required under
the E‐Government Act of 2002 and the Homeland Security Act of 2002.
Please complete this form and send it to the DHS Privacy Office:
Rebecca J. Richards
Director of Privacy Compliance
The Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
Tel: 571‐227‐3813
Fax: 571‐227‐4171
[email protected]
Upon receipt, the DHS Privacy Office will review this form. If a PIA is required, the DHS Privacy Office
will send you a copy of the Official Privacy Impact Assessment Guide and accompanying Template to
complete and return.
A copy of the Guide and Template is available on the DHS Privacy Office website, www.dhs.gov/privacy,
on DHSOnline and directly from the DHS Privacy Office via email: [email protected], phone: 571‐227‐3813,
and fax: 571‐227‐4717.
The Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
571-227-3813, [email protected]
www.dhs.gov/privacy
Privacy Threshold Analysis
Version date: November 13, 2006
Page 2 of 5
PRIVACY THRESHOLD ANALYSIS (PTA)
Please complete this form and send it to the DHS Privacy Office.
Upon receipt, the DHS Privacy Office will review this form
and may request additional information.
SUMMARY INFORMATION
DATE submitted for review: November 27, 2006
NAME of Project:
Name of Component: Preparedness
Name of Project Manager:
Email for Project Manager: < [email protected] .>
Phone number for Project Manger: <703‐607‐4933>
TYPE of Project:
Information Technology and/or System ∗
A Notice of Proposed Rule Making or a Final Rule.
∗
The E‐Government Act of 2002 defines these terms by reference to the definition sections of Titles 40 and
44 of the United States Code. The following is a summary of those definitions:
•“Information Technology” means any equipment or interconnected system or subsystem of
equipment, used in the automatic acquisition, storage, manipulation, management, movement,
control, display, switching, interchange, transmission, or reception of data or information. See 40
U.S.C. § 11101(6).
•“Information System” means a discrete set of information resources organized for the collection,
processing, maintenance, use, sharing, dissemination, or disposition of information. See: 44. U.S.C. §
3502(8).
Note, for purposes of this form, there is no distinction made between national security systems or
technologies/systems managed by contractors. All technologies/systems should be initially reviewed
for potential privacy impact.
The Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
571-227-3813, [email protected]
www.dhs.gov/privacy
Privacy Threshold Analysis
Version date: November 13, 2006
Page 3 of 5
SPECIFIC QUESTIONS
1.
Describe the project and its purpose:
2.
Status of Project:
This is a new development effort.
This an existing project.
Date first developed:
Date last updated:
3.
If this project is a technology/system, does it relate solely to infrastructure? [For example, is
the system a Local Area Network (LAN) or Wide Area Network (WAN)]?
No. Please continue to the next question.
Yes. Is there a log kept of communication traffic?
No. Please continue to the next question.
Yes. What type of data is recorded in the log? (Please choose all that apply.)
Header
Payload Please describe the data that is logged.
The Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
571-227-3813, [email protected]
www.dhs.gov/privacy
Privacy Threshold Analysis
Version date: November 13, 2006
Page 4 of 5
4.
Could the project relate in any way to an individual?∗
No. Please skip ahead to question 6.
Yes. Please provide a general description, below.
5.
What information about individuals could be collected, generated or retained?
6.
Is there a Certification & Accreditation record within OCIO’s FISMA tracking system?
Unknown.
No.
Yes. Please indicate the determinations for each of the following:
Confidentiality:
Integrity:
Availability:
∗
Low
Moderate
High
Undefined
Low
Moderate
High
Undefined
Low
Moderate
High
Undefined
Projects can relate to individuals in a number of ways. For example, a project may include a camera for
the purpose of watching a physical location. Individuals may walk past the camera and images of those
individuals may be recorded. Projects could also relate to individuals in more subtle ways. For example, a
project that is focused on detecting radioactivity levels may be sensitive enough to detect whether an
individual received chemotherapy.
The Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
571-227-3813, [email protected]
www.dhs.gov/privacy
Privacy Threshold Analysis
Version date: November 13, 2006
Page 5 of 5
PRIVACY THRESHOLD REVIEW
(To be Completed by the DHS Privacy Office)
DATE reviewed by the DHS Privacy Office: December 7, 2006
NAME of the DHS Privacy Office Reviewer: Rebecca J. Richards
DESIGNATION:
This is NOT a Privacy Sensitive System – the system contains no Personally Identifiable
Information.
This IS a Privacy Sensitive System
A PIA is required
National Security System
Legacy System
HR System
DHS PRIVACY OFFICE COMMENTS
PII is collected.
File Type | application/pdf |
File Title | DHS PRIVACY OFFICE |
Author | pia |
File Modified | 2006-12-07 |
File Created | 2006-12-07 |