Request for Emergency or Term Access to National Security (FD-1116)

Forms and Documents

Document Name	Status
Form FD-1116 Request for Emergency or Term Access to National Security Form	Unchanged
30 day FR notice for form FD-1116.pdf Supplementary Document	2015-07-09
60 Day FR notice for form FD-1116.pdf Supplementary Document	2015-07-09
FD-1116_83I.pdf Supplementary Document	2015-07-09
FD-1116_Supporting Statement.docx Supporting Statement A	2015-07-08
FD-1116_EO-12968.pdf Supplementary Document	2015-03-20
FD-1116_icd-704.pdf Supplementary Document	2015-03-20
FD-1116_ICD-703.pdf Supplementary Document	2015-03-20
FD-1116_EO-13549.pdf Supplementary Document	2015-03-20

IC Document Collections

IC ID	Document Title	Status
215769	Request for Emergency or Term Access to National Security Form	Unchanged

ICR Details

OMB Control No: 1110-0066	ICR Reference No: 201507-1110-002
Status: Historical Active	Previous ICR Reference No: 201503-1110-002
Agency/Subagency: DOJ/FBI	Agency Tracking No:
Title: Request for Emergency or Term Access to National Security (FD-1116)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/15/2015
	Date Received in OIRA: 07/09/2015
Terms of Clearance: In accordance with 5 CFR 1320, this information collection is approved for 3 years.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2018	36 Months From Approved
Responses	500	0	0
Time Burden (Hours)	23	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: FBI, Security Division (SecD) is requesting PRA approval of a form to collect initial and limited background information from private sector partners. This collection will be the minimum amount of information needed to initiate a background investigation before granting limited access to classified information to un-cleared partners.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 23290	04/27/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 38472	07/06/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Request for Emergency or Term Access to National Security	FD-1116	Request for Emergency or Term Access to National Security

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	500	0	0	500	0	0
Annual Time Burden (Hours)	23	0	0	23	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: New Collection

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Annual Cost to Federal Government: $27,500

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/09/2015

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