Form DHS Form 9007 DHS Form 9007 CSAT Top-Screen

CSAT Top-Screen
Questions
January 2009
Version 2.8

CSAT Top-Screen Questions

OMB PRA # 1670-0007
Expires: 5/31/2011

General
The Department of Homeland Security will use the information you provide in this TopScreen/Chemical Security Assessment Tool to determine whether particular facilities
present a high level of security risk. Your provision of accurate information in this TopScreen is critical to enabling the Department to make well informed decisions designed to
reduce the Nation's risk.
The Department will base its determinations, in part, upon the information provided in this
Top-Screen/Chemical Security Assessment Tool. The information provided in the TopScreen/Chemical Security Assessment Tool will not, therefore, be the sole or definitive
basis upon which the Department will categorize facilities as presenting a high level of
security risk.
In the first part of the Top-Screen/Chemical Security Assessment Tool, the Department
seeks information concerning the presence and amounts of certain chemicals. The
presence or amount of a particular chemical is not the sole factor in determining whether a
facility presents a high level of security risk. This information informs the subsequent
parts of the Departments assessment. The Department will use its best judgment and all
available information in determining whether a facility presents a high level of security
risk.
Paperwork Burden Notice:
The public reporting burden for this form is estimated to be 30.3 hours. The burden
estimate includes time for reviewing instructions, researching existing data sources,
gathering and maintaining the needed data, and completing and submitting the form. Send
comments regarding the accuracy of the burden estimate and any suggestions for
reducing the burden to: NPPD/OIP/Infrastructure Security Compliance Division, Attention:
Dennis Deziel, Project Manager, U.S. Department of Homeland Security, Mail Stop 8100,
Washington, DC 20528-8100.
(Paperwork Reduction Project (1670-0007)). Your response is mandatory according to
Public Law 109- 295 Section 550. You are not required to respond to this collection of
information unless a valid OMB control number is displayed in the upper right corner of
this form. NOTE: DO NOT send your completed form to this address.
Submission Statement:
My statements in this submission are true, complete, and correct to the best of my
knowledge and belief and are made in good faith. I understand that a knowing and willful
false statement on this form can be punished by fine or imprisonment or both. (See
section 1001 of title 18, United States Code).

DHS Form 9007

Page 6 of 167

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CSAT Top-Screen Questions

OMB PRA # 1670-0007
Expires: 5/31/2011

Facility Description
Choose the facility type that best describes your facility
[Q:1.1-65]

Chemical manufacturing, usage, storage, and distribution
Petroleum refining
Liquefied natural gas storage

Facility Regulatory Mandates
Is the facility regulated pursuant to the Maritime Transportation Security Act of 2002,
Public Law 107-295, as amended?
[Q:1.3-85]

Yes, the facility is regulated pursuant to MTSA.
No, the facility is not regulated pursuant to MTSA
Partially: The site includes both a facility regulated pursuant to MTSA and a facility not
regulated pursuant to MTSA.
If the site includes both a facility regulated pursuant to the Maritime Transportation Security Act
of 2002, Public Law 107-295, as amended, and a facility not regulated pursuant to the Maritime
Transportation Security Act, select "Partially" and continue to fill out the screen for the facility not
subject to the Maritime Transportation Security Act.
Is the facility a Public Water Systems, as defined by section 1401 of the Safe Drinking Act,
Public Law 93-523, as amended?
[Q:1.3-86]

Yes, the facility is a Public Water System.
No, the facility is not a Public Water System.
Partially: the facility contains a Public Water System regulated under the Safe Drinking
Water Act, but also contains components that are not so regulated.
If the facility contains a Public Water System as defined by the Safe Drinking Water Act, but
also contains components that are not covered by that definition, select "Partially" and continue to
fill out the screen for the portion of the facility not so defined under the Safe Drinking Water Act.

DHS Form 9007

Page 7 of 167

Version 2.8

CSAT Top-Screen Questions

OMB PRA # 1670-0007
Expires: 5/31/2011

Is the facility regulated as a Treatment Works as defined in section 212 of the Federal
Water Pollution Control Act, Public Law 92-500, as amended?
[Q:1.3-87]

Yes, the facility is regulated as a Treatment Works.
No, the facility is not regulated as a Treatment Works.
Partially: the site contains Treatment Works regulated under the Federal Water Pollution
Control Act, but also contains a facility or portion of a facility not so regulated.
If the facility contains a Treatment Works as defined by the Federal Water Pollution Control Act,
but also contains components that are not covered by that definition, select "Partially" and
continue to fill out the screen for the portion of the facility not so defined under the Federal Water
Pollution Control Act.
Is the facility owned or operated by the Department of Defense?
[Q:1.3-88]

Yes
No
For further information or discussion of this type of exemption, please refer to the Interim Final
Rule.
Is the facility owned or operated by the Department of Energy?
[Q:1.3-89]

Yes
No
For further information or discussion of this type of exemption, please refer to the Interim Final
Rule.

Is the facility subject to regulation by the Nuclear Regulatory Commission?
[Q:1.3-90]

Yes
No
For further information or discussion of this type of exemption, please refer to the Interim Final
Rule.

DHS Form 9007

Page 8 of 167

Version 2.8

CSAT Top-Screen Questions

OMB PRA # 1670-0007
Expires: 5/31/2011

Release Toxics
Release Toxic Chemicals of Interest
The presence or amount of a particular chemical is not the sole factor in determining whether a facility presents a high level of security
risk. This information informs the subsequent parts of the Department's assessment. The Department will use its best judgment and all
available information in determining whether a facility presents a high level of security risk.
Do you manufacture, process, use, store, or distribute any of the following release toxic chemicals of interest (COI) at or above the
screening threshold quantity at your facility?
Check "Yes" if the facility either currently possesses or possessed within the past 60 days the COI at or above the screening threshold
quantity.
(The default settings on this list indicate that the chemicals are NOT currently present on site nor have been onsite within the past 60
days. At the end of the list, you must indicate that these settings have been changed as applicable to the facility.)
These chemicals were determined by the US Department of Homeland Security to be a potential security risk at "high risk chemical facilities" as
defined in Section 550 the Department of Homeland Security Act of 2007. A facility should indicate which COI it either currently possesses or
possessed within the past 60 days at or above the screening threshold quantity.
If “No” selected for all chemicals, go to Release Flammables (page 44)

DHS Form 9007

Page 14 of 167

Version 2.8

CSAT Top-Screen
Top-Screen Questions

OMB PRA # 1670-0007
Expires: 5/31/2011

[Q:2.0-121]

Chemical Name

CAS#

Min. Conc.

Screening
Threshold
Quantity

Do you manufacture, process, use,
store, or distribute any of the following
release toxic chemicals of interest (COI)
at or above the screening threshold
quantity at your facility?
Yes

Acrolein
[2-Propenal or Acrylaldehyde]

107-02-8

1.00%

5,000 lbs

Allyl alcohol
[2-Propen-1-ol]

107-18-6

1.00%

15,000 lbs

Ammonia (anhydrous)

7664-41-7

1.00%

10,000 lbs

Ammonia (conc. 20% or greater)

7664-41-7

20.00%

20,000 lbs

Arsenic trichloride
[Arsenous trichloride]

7784-34-1

1.00%

15,000 lbs

Arsine

7784-42-1

1.00%

1,000 lbs

Boron trichloride
[Borane, trichloro]

10294-34-5

1.00%

5,000 lbs

Boron trifluoride
[Borane, trifluoro]

7637-07-2

1.00%

5,000 lbs

Boron trifluoride compound with methyl
ether (1:1)
[Boron, trifluoro [oxybis (methane)]-, T-4-]

353-42-4

1.00%

15,000 lbs

Bromine

7726-95-6

1.00%

10,000 lbs

75-15-0

1.00%

20,000 lbs

Carbon disulfide

DHS Form 9007

Page 15 of 167
167

No

Version 2.8

CSAT Top-Screen Questions

Chemical Name

OMB PRA # 1670-0007
Expires: 5/31/2011

CAS#

Min. Conc.

Screening
Threshold
Quantity

Do you manufacture, process, use,
store, or distribute any of the following
release toxic chemicals of interest (COI)
at or above the screening threshold
quantity at your facility?
Yes

Chlorine

7782-50-5

1.00%

2,500 lbs

Chlorine dioxide
[Chlorine oxide, ClO2]

10049-04-4

1.00%

1,000 lbs

Chloroform
[Methane, trichloro-]

67-66-3

1.00%

20,000 lbs

Chloromethyl ether
[Methane, oxybis(chloro-)]

542-88-1

1.00%

1,000 lbs

Chloromethyl methyl ether
[Methane, chloromethoxy-]

107-30-2

1.00%

5,000 lbs

Cyanogen chloride

506-77-4

1.00%

10,000 lbs

Cyclohexylamine
[Cyclohexanamine]

108-91-8

1.00%

15,000 lbs

19287-45-7

1.00%

2,500 lbs

Epichlorohydrin
[Oxirane, (chloromethyl)-]

106-89-8

1.00%

20,000 lbs

Ethylenediamine
[1,2-Ethanediamine]

107-15-3

1.00%

20,000 lbs

Fluorine

7782-41-4

1.00%

1,000 lbs

Diborane

DHS Form 9007

Page 16 of 167
167

No

Version 2.8

CSAT Top-Screen Questions

Chemical Name

OMB PRA # 1670-0007
Expires: 5/31/2011

CAS#

Min. Conc.

Screening
Threshold
Quantity

Do you manufacture, process, use,
store, or distribute any of the following
release toxic chemicals of interest (COI)
at or above the screening threshold
quantity at your facility?
Yes

Formaldehyde (solution)

50-00-0

1.00%

15,000 lbs

7647-01-0

37.00%

15,000 lbs

74-90-8

1.00%

2,500 lbs

Hydrofluoric acid (conc. 50% or greater)

7664-39-3

50.00%

1,000 lbs

Hydrogen chloride (anhydrous)

7647-01-0

1.00%

5,000 lbs

Hydrogen fluoride (anhydrous)

7664-39-3

1.00%

1,000 lbs

Hydrogen sulfide

7783-06-4

1.00%

10,000 lbs

Isobutyronitrile
[Propanenitrile, 2-methyl-]

78-82-0

1.00%

20,000 lbs

Isopropyl chloroformate
[Carbonochloridic acid, 1-methylethyl ester]

108-23-6

1.00%

15,000 lbs

Methacrylonitrile
[2-Propenenitrile, 2-methyl-]

126-98-7

1.00%

10,000 lbs

Methyl hydrazine
[Hydrazine, methyl-]

60-34-4

1.00%

15,000 lbs

Methyl isocyanate
[Methane, isocyanato-]

624-83-9

1.00%

10,000 lbs

Hydrochloric acid (conc. 37% or greater)
Hydrocyanic acid

DHS Form 9007

Page 17 of 167
167

No

Version 2.8

CSAT Top-Screen Questions

Chemical Name

OMB PRA # 1670-0007
Expires: 5/31/2011

CAS#

Min. Conc.

Screening
Threshold
Quantity

Do you manufacture, process, use,
store, or distribute any of the following
release toxic chemicals of interest (COI)
at or above the screening threshold
quantity at your facility?
Yes

Methyl thiocyanate
[Thiocyanic acid, methyl ester]

556-64-9

1.00%

20,000 lbs

Nitric acid

7697-37-2

80.00%

15,000 lbs

Nitric oxide
[Nitrogen oxide (NO)]

10102-43-9

1.00%

10,000 lbs

Oleum (Fuming Sulfuric acid)
[Sulfuric acid, mixture with sulfur trioxide]

8014-95-7

1.00%

10,000 lbs

Perchloromethylmercaptan
[Methanesulfenyl chloride, trichloro-]

594-42-3

1.00%

10,000 lbs

Phosgene
[Carbonic dichloride] or [carbonyl dichloride]

75-44-5

1.00%

500 lbs

Phosphorus oxychloride
[Phosphoryl chloride]

10025-87-3

1.00%

5,000 lbs

Phosphorus trichloride

7719-12-2

1.00%

15,000 lbs

Propionitrile
[Propanenitrile]

107-12-0

1.00%

10,000 lbs

Propyleneimine
[Aziridine, 2-methyl-]

75-55-8

1.00%

10,000 lbs

7446-09-5

1.00%

5,000 lbs

Sulfur dioxide (anhydrous)

DHS Form 9007

Page 18 of 167

No

Version 2.8

CSAT Top-Screen Questions

Chemical Name

OMB PRA # 1670-0007
Expires: 5/31/2011

CAS#

Min. Conc.

Screening
Threshold
Quantity

Do you manufacture, process, use,
store, or distribute any of the following
release toxic chemicals of interest (COI)
at or above the screening threshold
quantity at your facility?
Yes

Sulfur tetrafluoride
[Sulfur fluoride (SF4), (T-4)-]

7783-60-0

1.00%

2,500 lbs

Sulfur trioxide

7446-11-9

1.00%

10,000 lbs

75-74-1

1.00%

10,000 lbs

7550-45-0

1.00%

2,500 lbs

Tetramethyllead
[Plumbane, tetramethyl-]
Titanium tetrachloride
[Titanium chloride (TiCl4) (T-4)-]

No

The list above has been reviewed and all chemicals of interest that the facility either currently possesses or possessed within the past
60 days at or above the screening threshold quantity have been indicated by selecting "Yes."
[Q:2.0-631]

Yes
No

DHS Form 9007

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167

Version 2.8