83i

PA PERW ORK REDUCTION A CT SUBM ISSION

Please read the instructions before completing this form. For additional forms or assistance in completing this form, contact your agency's Paperwork
Clearance Officer. Send two copies of this form, the collection instrument to be reviewed, the Supporting Statement, and any additional documentation
to: Office of Information and Regulatory Affairs, Office of Management and Budget, Docket Library, Room 10102, 725 17th Street NW,
Washington, DC 20503.
1. Agency/Subagency originating request

2. OM B control nu mbe r
a. 1110

DOJ-FBI, Cyber Division

-

b.

3. Type of information collection (check one)
New collection
a.
Revision of a currently approved collection
b.
✔
c.
Extension, without change, of a currently approved collection
Reinstatement, without change, of a previously approved collection for
d.
which approval has expired
Reinstatement, with change, of a previously approved collection for which
e.
approval has expired
f.
Existing collection in use without an OMB control number

4. Type of review requested (check one)
a. ✔ Regular
Em ergency - A pproval reque sted by:
b.
c.
Delegated

3a. Public C omm ents
Has the agency received public comments on this information collection?

6. Requ ested expiration d ate
a. ✔ Three years from approval date

✔

Yes

None

0049

/

/

5. Small entities
Will this information collection have a significant economic impact on a
✔ No
Yes
substantial number of small entities?

b.

Other Specify:

/

No

7. Title

InfraGard Membership Application and Profile Questionnaire
8. Agenc y form num ber(s) (if applicable)

N/A
9. Keywords

InfraGard Membership Application and Profile Questionnaire; Public Private Alliance; National Industry Partnerships
10. Abstract

Searchable database of applicants and members personal and private information used for vetting purposes by the FBI for
InfraGard membership, sector assignment and expertise of critical infrastructure protection.

11. Affected public (Mark primary with "P" and all others that apply with "X")
a. P Individuals or households
b. X Bus iness or othe r for-pro fit
c. X Not-for-profit institutions

d. X F a rm s
e. X Federal Government
f. X State, Local or T ribal Govern men t

13. Annual reporting and recordkeeping hour burden
a. Num ber of respond ents
b. Total annual responses
1.Percentage of these responses

collected electronically

c. Total annual hours requested
d. Current O MB inventory
e. Difference
f. Explanation of difference
1. Program change
2. Adjustment
15. Purpose of information collection
others that apply with "X")

a.
Application for be nefits
b.
Program evaluation
c.
General purpose statistics
d.
Aud it

%

P Program planning or management
X Research
Regulatory or compliance

17. Statistical methods
Does this information collection employ statistical methods?
Yes

OMB 83-I

✔ No

P

Voluntary
Required to obtain or retain bene fits
Mand atory

14. Annual reporting and recordkeeping cost burden (in thousands of dollars)
a. Total annualized capital/startup costs
b . T o ta l a nn ua l c os ts (O & M )

c. Total annualized cost requested

d. Current O MB inventory
e. Difference
f. Explanation of difference
1. Program change
2. Adjustment

0
N/A

(M ark prim ary with "P " an d all
e.
f.
g.

a.
b.
c.

0

55,000
7200

100
3600
0

12. Obligation to respond (Mark primary with "P" and all others that apply with "X")

N/A
0

0
0

16. Frequency of recordkeeping or reporting (check all that apply)

a.
b.
Reco rdkeeping
Third party disc losure
c. ✔ Reporting
1.
2.
3.
On occ asion
Wee kly
Mo nthly
4.
Quarterly
5.
Sem i-annually 6.
Ann ually
7.
Biennially
8.
Other (de scribe)
18. Agen cy contact (person who can bes t ans we r qu es tion s reg ard ing the c on ten t of this
submission)
Nam e:

Lisa Avery, Program Analyst - FBI Cyber Div.

Phone:

202-651-3227
02/04