Tracking Log for CVI Received Instrument Scope

Tracking Log For CVI Received Instrument

Name of Instrument

Tracking Log for CVI Received

Scope of Instrument

This instrument collects:

• Personally identifiable information of CVI Authorized Users

• Date CVI was shared

• Description of the nature of CVI (e.g., Top-Screen);

• PII for the coved person with who information was shared

• How CVI was shared

Example of DHS Form used within the scope of this instrument

Attached is DHS Form 9025 that may be used to collect information within this instrument. DHS Form 9025 identifies some, but not all of the data collected under this instrument.

DHS Form 9025 is not mandatory by DHS, however it’s encouraged to be used by CVI Authorized Users. Current version of DHS Form 9025 may be found at www.dhs.gov/chemicalsecurity.