Security

Forms and Documents

Document Name	Status
Form DOE-F-5639.3 Security Form	Modified
1910-1800 Details for ITEM 12 and 13 Supporting Statement 6-19-12.xls Supplementary Document	2012-07-23
Supporting_Statement_1910-1800 Response to OMB Comments 6-26-12 Final.doc Supporting Statement A	2012-07-23
1910-1800 Details for ITEM 12 Supporting Statement 2-10-12.xls Supplementary Document	2012-03-20
Descriptions of Collections 2-10-12.docx Supplementary Document	2012-03-20

IC Document Collections

IC ID	Document Title	Status
23402	Security Form	Modified

ICR Details

OMB Control No: 1910-1800	ICR Reference No: 201203-1910-012
Status: Historical Active	Previous ICR Reference No: 200809-1910-004
Agency/Subagency: DOE/DOEOA	Agency Tracking No: Felecia Briggs
Title: Security
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/06/2014
	Date Received in OIRA: 05/10/2012
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is approved for three years. NMMSS information collections removed form this authorization must be separately authorized through another ICR if the information collection activities continue; otherwise any such collections will be in violation of the Paperwork Reduction Act.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2017	36 Months From Approved	11/30/2014
Responses	81,669	0	121,637
Time Burden (Hours)	71,206	0	264,023
Cost Burden (Dollars)	0	0	0

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Abstract: Collections are used by DOE management to exercise management oversight and control over management and operating (M&O) contractors of DOE's government-owned contractor-operated (GOCO) facilities and offsite contractors. The "oversight and control" function concerns ways in which DOE contractors provide goods and services to DOE organizations and activities in accordance with the therms of their contracts, government regulations, etc. Information is collected from DOE contractors and the public

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Authorizing Statute(s): PL: Pub.L. 95 - 91 214, 644, 646(a) Name of Law: Department of Energy Organization Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 28	02/10/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 76	04/19/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Security	DOE-F-471.1, DOE-F-5639.3, DOE F 5631.20, DOE F 5631.29, DOE F 5631.18, DOE F 5631.5, DOE-F-5631.34, SF-328	US Department of Energy Report of Security Incident/Infraction ,   Certificate Pertaining to Foreign Interests ,   US Department of Energy Office of Safeguards and Security Security Incident Notification Report ,   US Department of Energy Request for Visit or Access Approval ,   The Conduct of Personnel Security Interviews Under DOE Security Regulations ,   Security Acknowledgement ,   Security Termination Statement ,   US Department of Energy Data Report on Spouse/Cohabitant

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	81,669	121,637	0	0	-39,968	0
Annual Time Burden (Hours)	71,206	264,023	0	0	-192,817	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Changes in the 1910-1800 Security package are listed below: Nuclear Materials Management and Safeguards System (NMMSS): The following forms have been removed from this collection package as the NMMSS management and operations of the program were transferred from the Office of Health, Safety and Security (HSS) to the National Nuclear Security Administration (NNSA) on October 1, 2011. NMMSS is sponsored by the NNSA Office of Nuclear Materials Integration (NA-73) and the U.S. Nuclear Regulatory Commission (NRC). • DOE/NRC F 740M, Concise Note (Preprinted) • DOE/NRC F 741, Nuclear Material Transaction Report • DOE/NRC F 742, Material Balance Report • DOE/NRC F 742C, Physical Inventory • DOE F DP-749, ADP Transcription Sheet Internal Project Transfers

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Annual Cost to Federal Government: $1,280,232

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/10/2012

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