Security

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DOE F 5631.20 US Department of Energy Request for Visit or Access Approval	Form	Modified	Available
Form DOE-F-471.1 US Department of Energy Office of Safeguards and Security Security Incident Notification Report	Form	Modified	Available
Form SF-328 Certificate Pertaining to Foreign Interests	Form	Modified	Available
Form DOE/NRC-F-749 US Department of Energy ADP Transcription Sheet Internal Project Transfers	Form	Modified	Available
Form DOE/NRC-F-742 US Department of Energy and US Nuclear Regulatory Commission Material Balance Report	Form	Modified	Available
Form DOE/NRC-F-741 US Department of Energy and US Nuclear Regulatory Commission Nuclear Material Transaction Report	Form	Modified	Available
Form DOE/NRC-F-742C US Department of Energy and US Nuclear Regulatory Commission Physical Inventory Listing	Form	Modified	Available
Form DOE/NRC-F-740M US Department of Energy and US Nuclear Regulatory Commission Concise Note	Form	Modified	Available
Form DOE-F-5631.34 US Department of Energy Data Report on Spouse/Cohabitant	Form	Modified	Available
Form DOE-F-5639.3 US Department of Energy Report of Security Incident/Infraction	Form	Modified	Available
Form DOE F 5631.29 Security Termination Statement	Form	Modified	Available
Form DOE F 5631.18 Security Acknowledgement	Form	Modified	Available
Form DOE F 5631.5 The Conduct of Personnel Security Interviews Under DOE Security Regulations	Form and Instruction	Modified	Available
Form DOE F 472.1 Fair Credit Reporting Act Authorization	Form and Instruction	Modified	Available
1910-1800 support statement 08-2008-revised 3.xls	Supplementary Document	Uploaded 2009-05-27	Available
Descriptions of Collections 4-30-09.doc	Supplementary Document	Uploaded 2009-05-01	Available
1910-1800 support statement 08-2008-revised 2.xls	Supplementary Document	Uploaded 2009-05-01	Available
Supporting Statement 1910-1800 2008-revised final.doc	Supporting Statement A	Uploaded 2009-05-01	Available
support statement 08-2008.xls	Supplementary Document	Uploaded 2008-09-11	Available
Descriptions of Collections 8-2008.doc	Supplementary Document	Uploaded 2008-09-11	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
23402	Security	Form	Modified	US Department of Energy Request for Visit or Access Approval
23402	Security	Form	Modified	US Department of Energy Office of Safeguards and Security Security Incident Notification Report
23402	Security	Form	Modified	Certificate Pertaining to Foreign Interests
23402	Security	Form	Modified	US Department of Energy ADP Transcription Sheet Internal Project Transfers
23402	Security	Form	Modified	US Department of Energy and US Nuclear Regulatory Commission Material Balance Report
23402	Security	Form	Modified	US Department of Energy and US Nuclear Regulatory Commission Nuclear Material Transaction Report
23402	Security	Form	Modified	US Department of Energy and US Nuclear Regulatory Commission Physical Inventory Listing
23402	Security	Form	Modified	US Department of Energy and US Nuclear Regulatory Commission Concise Note
23402	Security	Form	Modified	US Department of Energy Data Report on Spouse/Cohabitant
23402	Security	Form	Modified	US Department of Energy Report of Security Incident/Infraction
23402	Security	Form	Modified	Security Termination Statement
23402	Security	Form	Modified	Security Acknowledgement
23402	Security	Form and Instruction	Modified	The Conduct of Personnel Security Interviews Under DOE Security Regulations
23402	Security	Form and Instruction	Modified	Fair Credit Reporting Act Authorization

ICR Details

OMB Control No: 1910-1800	ICR Reference No: 200809-1910-004
Status: Historical Active	Previous ICR Reference No: 200509-1910-001
Agency/Subagency: DOE/DOEOA	Agency Tracking No: Kathy Murphy
Title: Security
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/02/2009
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/17/2008
Terms of Clearance: Corrections and clarifications made to spreadsheet, submitted forms, and supporting statement.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2012	36 Months From Approved	06/30/2009
Responses	121,637	0	63,841
Time Burden (Hours)	264,023	0	249,955
Cost Burden (Dollars)	0	0	0

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Abstract: Collections are used by DOE management to exercise management oversight and control over management and operating (M&O) contractors of DOE's government-owned contractor-operated (GOCO) facilities and offsite contractors. The "oversight and control" function concerns ways in which DOE contractors provide goods and services to DOE organizations and activities in accordance with the therms of their contracts, government regulations, etc. Information is collected from DOE contractors and the public

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Authorizing Statute(s): PL: Pub.L. 95 - 91 214, 644, 646(a) Name of Law: Department of Energy Organization Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 108	06/04/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 181	09/17/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Security	SF-328, DOE-F-471.1, DOE-F-5631.34, DOE/NRC-F-740M, DOE/NRC-F-742C, DOE/NRC-F-741, DOE/NRC-F-742, DOE/NRC-F-749, DOE-F-5639.3, DOE F 5631.20, DOE F 5631.29, DOE F 5631.18, DOE F 472.1, DOE F 5631.5	US Department of Energy Report of Security Incident/Infraction ,   US Department of Energy Data Report on Spouse/Cohabitant ,   US Department of Energy and US Nuclear Regulatory Commission Concise Note ,   US Department of Energy and US Nuclear Regulatory Commission Physical Inventory Listing ,   US Department of Energy and US Nuclear Regulatory Commission Nuclear Material Transaction Report ,   US Department of Energy and US Nuclear Regulatory Commission Material Balance Report ,   US Department of Energy ADP Transcription Sheet Internal Project Transfers ,   Certificate Pertaining to Foreign Interests ,   US Department of Energy Office of Safeguards and Security Security Incident Notification Report ,   US Department of Energy Request for Visit or Access Approval ,   Fair Credit Reporting Act Authorization ,   The Conduct of Personnel Security Interviews Under DOE Security Regulations ,   Security Acknowledgement ,   Security Termination Statement

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ICR Summary of Burden

table that charts list of burden

	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	121,637	63,841	0	57,796	0	0
Annual Time Burden (Hours)	264,023	249,955	0	14,068	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This Program Change is due to a reorganization and the Foreign Travel Management System (FTMS) being transferred to Office of Management within DOE. In addition, the Foreign Access Central Tracking System (FACTS) estimates of annual respondents and annual burden hours increased, due to increased utilization of FACTS by DOE sites and foreign nationals visiting and assigned to DOE sites.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 09/17/2008

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