DHS Form 9002.2 Chemical Security Assessment Tool (CSAT) User Informatio

OMB No. 1670-0007
Expiration Date: May 31, 2011
DEPARTMENT OF HOMELAND SECURITY

Chemical Security Assessment Tool (CSAT)
User Information Change Request Form
Please read the instructions carefully before completing this form. The instructions must be available during
completion of this form.
Section A: CSAT User Information to Update
1. User Name
1b. Last Name

1a. First Name

2. CSAT User Name

4. User Role:

1c. Middle Initial

3. CVI Authorized User Number

Preparer

Submitter

Authorizer

Other

5. User Mailing Address Information
5b. City

5a. Mailing Address

5d. Zip Code

5c. State

6. User Contact Information
6a. Phone Number

6b. Phone Extension

7. Email Address

8. Is the user a U.S. Citizen?

Yes

No

9. Is the User an Officer of the Corporation or an employee designated by the Officer of the Corporation?

Yes

No

10. Is User domiciled in the U.S.?

Yes

No

Section B: Signatures
11a. User Name

11b.User Signature

11c. Date

12a. Authorizer Name

12b. Authorizer Signature

12c. Date

13a. Authorizer CSAT User Name

13b. Authorizer CVI User Number

13c. Date

DHS Form 9002.2 (9/09)

For questions and assistance, please call the CFATS Helpdesk at 1-866-323-2957
Monday - Friday 7:00a.m. - 7:00p.m., Eastern Time
Not open on federal holidays

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OMB No. 1670-0007
Expiration Date: May 31, 2011

PRIVACY ACT STATEMENT
1.

Authority: Section 550 (c) of Public Law 109-295 and implementing regulations, 6 CFR Part 27.

2.

Purpose: This form allows a CSAT user to update his/her information.

3.

Routine Uses: The Personal Identifiable Information will be used by and disclosed pursuant to a published Privacy

Act System of Records Notice. CFATS PII is collected under the General Information Technology Access Account
Records System (GITAARS) http://edocket.access.gpo.gov/2008/E8-10895.htm DHS/ALL-004
4.

Disclosure: Furnishing this information is required pursuant to Section 550 (c) of Public Law 109-295
and implementing regulations, 6 CFR Part 27.

PAPERWORK REDUCTION ACT STATEMENT
In accordance with the Paperwork Reduction Act, no one is required to respond to a collection of information unless it
displays a valid OMB Control Number. The valid OMB Control Number for this information collection is 1670-0007.

INSTRUCTIONS
The instructions for completing this form can be found in the CSAT User Registration User Guide. The User Guide is
available at www.dhs.gov/chemicalsecurity.

DHS Form 9002.2 (9/09)

For questions and assistance, please call the CFATS Helpdesk at 1-866-323-2957
Monday - Friday 7:00a.m. - 7:00p.m., Eastern Time
Not open on federal holidays

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