Information Collection

Office of Emergency Communications Technical Assistance (TA) Evaluation Form - 9042

IC 197202 under ICR 201104-1670-003 · OMB 1670-0023.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1670-0023 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 9042 Office of Emergency Communications Technical Assistance (TA) Evaluation Form - 9042	Form
9042 Office of Emergency communications Technical Assistance TA Evaluation - DHS Form 9042 v8 draft.pdf	Form
DHS Form 9042_ PRA Statement.doc Privacy Act Statement	IC Document

IC Title:

Office of Emergency Communications Technical Assistance (TA) Evaluation Form - 9042

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	9042	Office of Emergency communications Technical Assistance (TA) Evaluation Form	TA Evaluation - DHS Form 9042 v8 draft.pdf		Yes	Yes	Fillable Printable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records

Title: Department of Homeland Security Mailing and Other Lists System of Records

FR Citation: 73 FR 228

Number of Respondents: 2,000

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	840	840
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Privacy Act Statement	DHS Form 9042_ PRA Statement.doc	04/08/2011

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