Narrative of Changes to Forms

SAFETY Act Form Changes.doc

Support Anti-terrorism by Fostering Effective Technologies Act of 2002

Narrative of Changes to Forms

OMB: 1640-0001

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SAFETY Act Form Changes

Changes to All Forms:

  1. Inserted OMB Form Number and Expiration Date in Header of documents as well as PRA Burden Statement to include DHS Form Number in Footer.

  2. Formatting changed to include 1” margins on all sides and consistent fonts and text sizes.

    1. This included ensuring all cover pages of forms had similar format.


DHS Form 10001: Application for Transfer of SAFETY Act Designation

  1. Question T1.2 added

  2. T3.1 and T3.3 added

  3. T6: Listed type of insurance information required for this question

  4. T7 added

  5. Instructions updated to reflect changes.

DHS Form 10002: Notice of Modification

  1. Expanded M3 to break out between M3.1 “Technical Modification” and M3.2 “Insurance Petition”

  2. Instructions updated to reflect changes.

DHS Form 10003: Notice of License

  1. No changes (other than formatting listed above)

DHS Form 10004: SAFETY Act Block Certification

  1. No changes (other than formatting listed above)

DHS Form 10005: SAFETY Act Block Designation

  1. No changes (other than formatting listed above)

DHS Form 10006: Application for Developmental Testing and Evaluation Designation

  1. TE5 Question reworded.

  2. Instructions updated to reflect changes.


DHS Form 10006: Application for Developmental Testing and Evaluation Designation

Previous CI

New CI

TE5 Question reworded.

Description Specification of your Technology. Describe your Technology in detail. This description will serve as the basis for the Department's analysis of your Technology for SAFETY Act Purposes. The content of the response you provide in this section, together with any additional information you may be asked to provide, may be used to finalize of the definition and scope of your Technology as it will appear in a Developmental Testing and Evaluation Designation.

Description of your Technology. One of the most important parts of the application process is defining the scope of your Technology. In this section, define your Technology with a sufficient degree of specificity. This description will serve as the basis for the Department’s analysis of your Technology for SAFETY Act purposes. The content of the response you provide in this section, together with any additional information you may be asked to provide, may be used to finalize the definition and scope of your Technology as it will appear in a Developmental Testing and Evaluation Designation.


DHS Form 10007: Application for SAFETY Act Certification

  1. No changes (other than formatting listed above)

DHS Form 10008: Application for SAFETY Act Designation

  1. D5 reworded.

  2. D8 condensed to remove repetitive instructions.

  3. D9 reworded.

  4. More detail to D10 added.

  5. More detail to D11 added.

  6. More detail to D14 added.

  7. Instructions updated to reflect changes.


DHS Form 10008: Application for SAFETY Act Designation

Previous CI

New CI

D5 reworded.

Nature of your Technology. If your Technology is a product or device, please describe the Technology in detail, including its principal elements, system and components. If your Technology is a service, please describe the nature of the service, the actions, activities, planning, training, and/or expertise involved in providing the service and how the service is designed to counter terrorist threats. If your Technology is an "integrator" of various products, services, or legacy systems indicate how the Technology will integrate the various component parts.

Summary of your Technology. Please provide a brief (no more than two-page) overall description of your Technology. If your Technology is a product or device, please describe the Technology, including its principal elements, subsystems and components. If your Technology is a service, please provide an overview of the nature of the service, the actions, activities, planning, training, and/or expertise involved in providing the service and how the service is designed to counter terrorist threats. If your Technology is an “integrator” of various products, services, or legacy systems, indicate how the Technology will integrate the various component parts.

D8 condensed to remove repetitive instructions.

Provide the earliest date of sale of the Technology for which you are requesting SAFETY Act coverage.

Provide the earliest date of sale of the Technology for which you are requesting SAFETY Act coverage. This should represent the date that the Technology was first deployed, used or modified to be used in an Anti-terrorism context. Please provide a justification of the date used.

D9 reworded.

Description of your Technology. Describe your Technology in detail. This description will serve as the basis for the Department's analysis of your Technology for SAFETY Act purposes. The content of the response you provide in the section, together with any additional information you may be asked to provide, may be used to finalize of the definition and scope of your Technology as it will appear in a Designation.

Description of your Technology. One of the most important parts of the application process is defining the scope of your Technology. In this section, define your Technology with a sufficient degree of specificity. This description will serve as the basis for the Department’s analysis of your Technology for SAFETY Act purposes. The content of the response you provide in this section, together with any additional information you may be asked to provide, may be used to finalize the definition and scope of your Technology as it will appear in a Designation. Refer to the instructions for a more detailed example.

More detail to D10 added.

Deployment and Operation. Describe the sequence of steps involved in deploying and operating your Technology.

Deployment and Operation. Describe the sequence of steps involved in deploying and operating your Technology. Provide sufficient detail to show that your company is capable of supplying your Technology. Be specific about all activities such as the development, implementation, operation and management, etc. required to deploy your Technology.

More detail to D11 added.

Readiness for Sale. How ready is your Technology to be sold and deployed?

Readiness for Sale. How ready is your Technology to be sold and deployed? Please describe any modifications, adjustments, start-up time, hiring and vetting of personnel, building of manufacturing facilities, or other processes which might be required prior to a new deployment.

More detail to D14 added.

Effectiveness and Utility. Provide information supporting the potential for your Technology to be effective in countering potential acts of terrorism. Please provide internal or external effectiveness tests or other information indicating the effectiveness of your Technology. This can include acceptance test data from a government contracting action, customer feedback or other relevant data or experience. As noted, acceptance of your Technology by a government purchaser may be highly relevant and expedite approval or your application.

Effectiveness and Utility. Provide information supporting the potential for your Technology to be effective in countering potential acts of terrorism. Please provide internal or external effectiveness tests or other information indicating the effectiveness of your Technology. This can include acceptance test data from a Government contracting action, penetration tests, case studies, pre and post-training testing, incident reports, customer feedback, or other relevant data or experience. As noted, acceptance of your Technology by a Government purchaser may be highly relevant and expedite approval of your application.


It is important that effectiveness data be in documented form if at all possible. You are responsible for providing all documentation in support of your application at the time of submittal, or to facilitate the transfer of any such information prior to submission. In the event that obtaining documentation is not possible and if POCs are provided as sources of information or testimonials, check below to indicate that you have contacted them and that they are expecting to hear from DHS related to your Technology. Also, indicate below specifically what information we should expect from each POC. Please see the Instructions for additional information.




DHS Form 10009: Application for a Pre-Application Consultation

  1. No changes (other than formatting listed above)

DHS Form 10010: Registration as a Seller

  1. No changes (other than formatting listed above)

DHS Form 10057: Application for Renewal

  1. This is a new form, so all content is original. (Form will be used when Anti-Terrorism technologies (ATT) are set to expire and require renewal in order to remain approval of SAFETY Act Designation or Certification).









File Typeapplication/msword
File TitleSAFETY Act Form Changes
AuthorMackenzie Kielman
Last Modified Byjeffery.harris
File Modified2009-12-22
File Created2009-10-14

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