Form DHS Form SF319 DHS Form SF319 TELECOMMUNICATIONS SERVICE PRIORITY (TSP) SYSTEM TSP SER

TELECOMMUNICATIONS SERVICE PRIORITY (TSP) SYSTEM
TSP SERVICE RECONCILIATION FOR SERVICE VENDORS

OMB No. 1670-0005
Expires: 08/31/2011

(See Instructions on back before completion.)

The public reporting burden for this collection of information is estimated to average 60 minutes per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden
estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to DHS, NPPD/CS&C/NCS (Attn: TSP Program Office), 245
Murray Lane, M/S 0615, Washington, DC 20528-8500. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any
penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

1. VENDOR NAME
2. TSP SERVICE INFORMATION
a. ITEM
NO.

b. TSP AUTHORIZATION CODE

1.

TSP

2.

TSP

3.

TSP

4.

TSP

5.

TSP

6.

TSP

7.

TSP

8.

TSP

9.

TSP

10.

TSP

11.

TSP

12.

TSP

13.

TSP

14.

TSP

15.

TSP

16.

TSP

17.

TSP

18.

TSP

19.

TSP

20.

TSP

c. PRIME SERVICE VENDOR CIRCUIT ID

3. POINT OF CONTACT
a. NAME

b. TITLE

c. (1) STREET ADDRESS

(2) CITY

d. TELEPHONE NUMBER (Area Code/Number/Extension)

e. ELECTRONIC MAILING ADDRESS

4. DATE DATA COMPILED (MMDDYYYY)

5. NUMBER OF ITEMS REPORTED

6.a. SIGNATURE

SEND COMPLETED FORM TO:

(3) STATE

(4) ZIP CODE

b. DATE

DHS, NPPD/CS&C/NCS
(Attn: TSP Program Office),
245 Murray Lane,
M/S 0615,
Washington, DC 20528-8500

AUTHORIZED FOR LOCAL REPRODUCTION
PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 319 (Revised 09/2010)

INSTRUCTIONS FOR TSP SERVICE RECONCILIATION
Complete this form only if the TSP Program Office has requested TSP reconciliation information from
your company.
If you are reconciling information on more than 20 TSP services (or 20 Prime Service Vendor
Service ID's), attach additional TSP Service Reconciliation forms (SF 319) or sheets of paper the same size
and format as the printed forms. Complete Items 3 through 6 on the first form only. List every Prime Service
Vendor Service ID for which your company is providing priority restoration (i.e., TSP restoration priority of 1, 2,
3, 4, or 5) as a prime contractor to a service user.
Item 1. Vendor Name. Enter full vendor name, exactly as previously submitted to the TSP Program
Office by your company.
Item 2. TSP Service Information. For each TSP service which you are reconciling, provide:
b. TSP Authorization Code. The TSP Control ID (positions 1-9 of the TSP Authorization Code) is the
only optional item on the form; the TSP Priority Levels (positions 11 and 12 of the TSP Authorization Code)
are required.
c. Prime Service Vendor Service ID. Enter the Circuit/Service ID. DO NOT enter segment numbers.
Item 3. Point of Contact. The point of contact is the representative of the prime service vendor who
will be called if there are any questions regarding information on this form. Enter name, title, full business
address and telephone number. Include electronic mailing address if available.
Item 4. Date Data Compiled. Enter the month, day, and year when data was compiled.
Item 5. Number of Items Reported. Enter the total number of items (Circuit/Service ID's) including those
reported on attached TSP Reconciliation Forms (SF 319) or sheets of paper.
Item 6. Signature and Date. The point of contact or a company official must sign and date the form.

Privacy Act Notice
Authority: This information collection is authorized by 5 U.S.C. §301 and 44 U.S.C. §3101.
Purpose: DHS will use this information to provide Telecommunications Service Priority (TSP) users and vendors
with information relating to TSP requests and to resolve specific cases of customer service.
Routine Uses: The information collected may be disclosed as generally permitted under 5 U.S.C. § 552a(b) of the
Privacy Act of 1974, as amended. This includes using the information, as necessary and authorized by the routine
uses published in DHS/ALL 002 Department of Homeland Security Mailing and Other Lists System.
Disclosure: Furnishing this information is voluntary; however, failure to furnish the requested information may delay
or prevent your registration or verification for continued use of service.
STANDARD FORM 319 (Revised 09/2010)(BACK)