CFATS Personnel Surety Background Check Form

Chemical Facility Anti-Terrorism Standards (CFATS) Personnel Surety Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1670-0029 can be found here:

Documents and Forms

Document Name Document Type
Form 11000-29 CFATS Personnel Surety Background Check Form Form
11000-29 Background Check to Identify Terrorist Ties for an Affec CFATS Personnel Surety Background Check Form (04 20 11) v1.pdf Form
CFATS PS Instrument Scope (04-20-11) - CLEAN.doc CFATS PS Instrument Scope IC Document

Information Collection (IC) Details

IC Title:	CFATS Personnel Surety Background Check Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 6 CFR 27

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	11000-29	Background Check to Identify Terrorist Ties for an Affected Individual at a High Risk Chemical Facility	CFATS Personnel Surety Background Check Form (04 20 11) v1.pdf		Yes	Yes	Fillable Fileable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records
Title: DHS/NPPD-002 CFATS Personnel Surety Prorgram System of Records	FR Citation: 76 FR 34732

Number of Respondents: 1,303,700	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,303,700	1,303,700
Annual IC Time Burden (Hours)	703,998	703,998
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CFATS PS Instrument Scope	CFATS PS Instrument Scope (04-20-11) - CLEAN.doc	05/03/2011

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