Information Collection

Security

IC 23402 under ICR 200809-1910-004 · OMB 1910-1800.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1910-1800 can be found here:

Documents and Forms

Document Name Document Type
Form DOE-F-5639.3 Security Form
DOE F 472.1 Fair Credit Reporting Act Authorization DOE F 472 1.pdf Form and Instruction
DOE F 5631.5 The Conduct of Personnel Security Interviews Under DOE S DOE F 5631 5.pdf Form and Instruction
DOE F 5631.18 Security Acknowledgement DOE F 5631 18.pdf Form
DOE F 5631.29 Security Termination Statement DOE F 5631 29.pdf Form
DOE-F-5639.3 US Department of Energy Report of Security Incident/Infr 5639-3.pdf Form
DOE-F-5631.34 US Department of Energy Data Report on Spouse/Cohabitant doe f 5631.34.pdf Form
DOE/NRC-F-740M US Department of Energy and US Nuclear Regulatory Commis nrc740m.pdf Form
DOE/NRC-F-742C US Department of Energy and US Nuclear Regulatory Commis NRC_742C.pdf Form
DOE/NRC-F-741 US Department of Energy and US Nuclear Regulatory Commis 741.pdf Form
DOE/NRC-F-742 US Department of Energy and US Nuclear Regulatory Commis doe-nrc f742.pdf Form
DOE/NRC-F-749 US Department of Energy ADP Transcription Sheet Internal 749.pdf Form
SF-328 Certificate Pertaining to Foreign Interests sf328.pdf Form
DOE-F-471.1 US Department of Energy Office of Safeguards and Securit 471-1.pdf Form
DOE F 5631.20 US Department of Energy Request for Visit or Access Appr 5631_20outside.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Security	Agency IC Tracking Number:	Kathy Murphy

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DOE-F-5639.3	US Department of Energy Report of Security Incident/Infraction	5639-3.pdf	Yes	Yes	Fillable Printable
Form	DOE-F-5631.34	US Department of Energy Data Report on Spouse/Cohabitant	doe f 5631.34.pdf	Yes	Yes	Fillable Printable
Form	DOE/NRC-F-740M	US Department of Energy and US Nuclear Regulatory Commission Concise Note	nrc740m.pdf	Yes	Yes	Fillable Printable
Form	DOE/NRC-F-742C	US Department of Energy and US Nuclear Regulatory Commission Physical Inventory Listing	NRC_742C.pdf	Yes	No	Fillable Printable
Form	DOE/NRC-F-741	US Department of Energy and US Nuclear Regulatory Commission Nuclear Material Transaction Report	741.pdf	Yes	Yes	Fillable Printable
Form	DOE/NRC-F-742	US Department of Energy and US Nuclear Regulatory Commission Material Balance Report	doe-nrc f742.pdf	Yes	No	Fillable Printable
Form	DOE/NRC-F-749	US Department of Energy ADP Transcription Sheet Internal Project Transfers	749.pdf	Yes	Yes	Fillable Printable
Form	SF-328	Certificate Pertaining to Foreign Interests	sf328.pdf	Yes	Yes	Fillable Printable
Form	DOE-F-471.1	US Department of Energy Office of Safeguards and Security Security Incident Notification Report	471-1.pdf	Yes	Yes	Fillable Printable
Form	DOE F 5631.20	US Department of Energy Request for Visit or Access Approval	5631_20outside.pdf	Yes	No	Fillable Printable
Form and Instruction	DOE F 5631.5	The Conduct of Personnel Security Interviews Under DOE Security Regulations	DOE F 5631 5.pdf	Yes	No	Printable Only
Form	DOE F 5631.18	Security Acknowledgement	DOE F 5631 18.pdf	Yes	No	Fillable Fileable Signable
Form	DOE F 5631.29	Security Termination Statement	DOE F 5631 29.pdf	Yes	No	Fillable Fileable Signable
Form and Instruction	DOE F 472.1	Fair Credit Reporting Act Authorization	DOE F 472 1.pdf	Yes	No	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: International Affairs and Commerce

Subfunction: Foreign Affairs

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 96,968	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 97 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	121,637	57,796	63,841
Annual IC Time Burden (Hours)	264,023	14,068	249,955
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.