Information Collection

CFATS Personnel Surety Background Check Form

IC 197566 under ICR 201105-1670-002 · OMB 1670-0029.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.