83c

PAPERWORK REDUCTION ACT

CHANGE WORKSHEET

Agency/subagency

OMB Control Number

Department of Homeland Security
National Protection and Programs Directorate
Office of Infrastructure Protection

0007
1670
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Enter only items that change
Current record

Agency form number (s)

CVI User Training (DHS Form 9012)

Contains a non-disclosure agreement
which must be completed to be a CVI
Authorized User.

New record

Non-disclosure agreement is replaced
by a few affirmative statements upon
conclusion of the training.

Annual reporting and recordkeeping hour
burden
Number of respondents
Total annual responses
Percent of these responses
collected electronically

%

%

Total annual hours
Difference
Explanation of difference
Program change
Adjustment
Annual reporting and recordkeeping cost
burden (in thousands of dollars)
Total annualized Capital/Startup costs
Total annual costs (O&M)
Total annualized cost requested
Difference
Explanation of difference
Program change
Adjustment
Other changes**

CVI User Training has been modified by removing the requirement of a non-disclosure agreement. Individuals will affirm
several statements and continue to provide the same PII.
Signature of Senior Official or designee:

** This form cannot be used to extend an expiration date.

OMB 83-C

Date:

For OIRA Use
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10/95