Form DHS Form 10012 (04 DHS Form 10012 (04 Information Request

TechSolutions Data Entry Instructions for
“Information Request Form”

Department Name:

Department of Homeland Security
Science and Technology Directorate
TechSolutions Program

OMB Control Number:

1640-0011

Expiration Date:

08/31/2010

Agency Form Number:

DHS Form 10012 (04/07)

Name of Form/Survey:

Information Request Form

Purpose of the Form:

To collect the necessary information required to document,
Assess and rank capability gaps submitted by the First
Responder community.

How to Submit:

All requests should be submitted electronically via
TechSolutions website
(https://www.techsolutions.dhs.gov).