Information Collection

Security

IC 23402 under ICR 201203-1910-012 · OMB 1910-1800.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1910-1800 can be found here:

Documents and Forms

Document Name Document Type
Form DOE-F-5639.3 Security Form
FACTS Login Page.pdf fnis.esportals.com Other-website
DOE F 472 1.pdf Other-Form Removed
DOE-F-5639.3 US Department of Energy Report of Security Incident/Infr 5639-3.pdf Form
DOE-F-5631.34 US Department of Energy Data Report on Spouse/Cohabitant DOE F 5631 34 (8-12-14).pdf Form
SF-328 Certificate Pertaining to Foreign Interests sf328.pdf Form
DOE-F-471.1 US Department of Energy Office of Safeguards and Securit 471-1.pdf Form
DOE F 5631.20 US Department of Energy Request for Visit or Access Appr 5631_20outside.pdf Form
DOE F 5631.5 The Conduct of Personnel Security Interviews Under DOE S DOE F 5631 5.pdf Form and Instruction
DOE F 5631.18 Security Acknowledgement DOE F 5631 18.pdf Form
DOE F 5631.29 Security Termination Statement DOE F 5631 29.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Security	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DOE-F-5639.3	US Department of Energy Report of Security Incident/Infraction	5639-3.pdf		Yes	Yes	Fillable Printable
Form	SF-328	Certificate Pertaining to Foreign Interests	sf328.pdf		Yes	Yes	Fillable Printable
Form	DOE-F-471.1	US Department of Energy Office of Safeguards and Security Security Incident Notification Report	471-1.pdf		Yes	Yes	Fillable Printable
Form	DOE F 5631.20	US Department of Energy Request for Visit or Access Approval	5631_20outside.pdf		Yes	No	Fillable Printable
Form and Instruction	DOE F 5631.5	The Conduct of Personnel Security Interviews Under DOE Security Regulations	DOE F 5631 5.pdf		Yes	No	Printable Only
Form	DOE F 5631.18	Security Acknowledgement	DOE F 5631 18.pdf		Yes	No	Fillable Fileable Signable
Form	DOE F 5631.29	Security Termination Statement	DOE F 5631 29.pdf		Yes	No	Fillable Fileable Signable
Other-website			FACTS Login Page.pdf	https://fnis.esportals.com	Yes	Yes	Fillable Fileable
Other-Form Removed			DOE F 472 1.pdf		Yes	Yes	Fillable Fileable
Form	DOE-F-5631.34	US Department of Energy Data Report on Spouse/Cohabitant	DOE F 5631 34 (8-12-14).pdf		Yes	Yes	Fillable Printable

Line of Business: International Affairs and Commerce

Subfunction: Foreign Affairs

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 81,669	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 97 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	81,669	-39,968	121,637
Annual IC Time Burden (Hours)	71,206	-192,817	264,023
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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