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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.