Information Collection

Request for Determination of CVI

IC 191764 under ICR 201303-1670-003 · OMB 1670-0015.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1670-0015 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DHS Form 9028 Request for Determination of CVI	Form and Instruction
DHS Form 9028 Request for Determination of Chemical-Terrorism Vulnerab Request for Determination of CVI 2.25.13.pdf	Form and Instruction

IC Title:

Request for Determination of CVI

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 and Instruction	DHS Form 9028	Request for Determination of Chemical-Terrorism Vulnerability Information (CVI)	Request for Determination of CVI 2.25.13.pdf		Yes	Yes	Fillable Printable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	300	50	250
Annual IC Time Burden (Hours)	75	12	63
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.