DHS Form 9010.1 CSAT Helpdesk Web Form

	Version 1.0
	OMB Control Number: 1670-0007 Expiration Date 3/31/2013

Chemical Security Assessment Tool
Helpdesk Web Form

In order to expedite the handling of your request, please provide the following information. We are required to input the information requested prior to providing an answer to questions that are received at the helpdesk for tracking purposes only.

If you are a covered facility, please provide your facility ID. If you have completed the registration process but do not know your coverage status, please include the registration form ID number that may be found in the registration email or on the printed form located below the barcode.

The information collected is secured as required by the Department of Homeland Security and cannot be accessed by any outside sources.

Submittal Form

Facility Name
First Name
Last Name
Phone Number
Fax Number
Facility Address (Street)
Facility Address (City, ST Zip)
Email Address
Re-enter Email Address for Confirmation
Registered CSAT User
Facility ID (if applicable)
User Registration (if applicable)
Brief description of question or issue	0 of 4000 * Fields with a red label are required.

Submit

Cancel

Should you need further assistance, please contact the CSAT helpdesk at 866-323-2957 and someone

will be able to help you.

Privacy Act Statement:

Authority: 5 U.S. C. § 301 and 44 U.S.C. § 3101 authorize the collection of this information.

Purpose: DHS will use this information to confirm your user role and respond to your questions.

Routine Use: This information 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 (DHS) Mailing and Other Lists System of Records (November 25, 2008, 73 FR 71659).

Disclosure: Furnishing this information is voluntary; however failure to provide any of the information requested may prevent the Chemical Facility Anti-Terrorism Standards (CFATS) Help Desk from providing assistance or answering your questions.

DHS Form 9010-1 (09/08)