"Department of Defense Security Agreement", "Appendage to Department of Defense Security Agreement", "Certificate Pertaining to Foreign Interests"

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DD Form 441 "Department of Defense Security Agreement", "Appendage to Department of Defense Security Agreement", "Certificate Pertaining to Foreign Interests"	Form	Modified	Available
TAB_B_Supporting_Statement_REVISON WHS Review Aug 30 2016 Rev 1HH (5) - CLEAN COPY.doc	Supporting Statement A	Uploaded 2016-08-31	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
5289	"Department of Defense Security Agreement", "Appendage to Department of Defense Security Agreement", "Certificate Pertaining to Foreign Interests"	Form	Modified

ICR Details

OMB Control No: 0704-0194	ICR Reference No: 201607-0704-003
Status: Historical Active	Previous ICR Reference No: 200803-0704-002
Agency/Subagency: DOD/DODDEP	Agency Tracking No:
Title: "Department of Defense Security Agreement", "Appendage to Department of Defense Security Agreement", "Certificate Pertaining to Foreign Interests"
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/08/2016
	Date Received in OIRA: 07/25/2016
Terms of Clearance: This collection is approved based on the revised materials provided by DOD.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2019	36 Months From Approved
Responses	6,851	0	0
Time Burden (Hours)	4,171	0	0
Cost Burden (Dollars)	182,702	0	0

---

Abstract: The execution of the DD Forms 441, 441-1 and SF 328 are factors in making a determination as to whether a contractor is eligible to have a facility security clearance. They are also a legal basis for imposing National Security Program (NISP) security requirements on eligible contractors.

---

Authorizing Statute(s): EO: EO 12829 Name/Subject of EO: National Industrial Security Program
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 27938	05/15/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 47790	07/22/2016
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
"Department of Defense Security Agreement", "Appendage to Department of Defense Security Agreement", "Certificate Pertaining to Foreign Interests"	SF 328, DD Form 441-1, DD Form 441	Department of Defense Security Agreement ,   Appendage to Department of Defense Security Agreement ,   Certificate Pertaining to Foreign Interests

---

ICR Summary of Burden

table that charts list 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	6,851	0	0	1,569	0	5,282
Annual Time Burden (Hours)	4,171	0	0	-3,663	0	7,834
Annual Cost Burden (Dollars)	182,702	0	0	-904,821	0	1,087,523

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

Burden Increase Due to:

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

Burden Reduction Due to: Miscellaneous Actions

Short Statement: An adjustment reflecting a change in burden hours was made based on the volume in forms submitted causing new estimates. Capital/Start up and Annualized Costs to Industry reflects a change, due to the estimated proportionate cost for the contractor’s purchase and/or maintenance of associated software and hardware in order to complete the forms. Adjustments in cost to the government are related to the estimated cost to receive and initially review the forms due to the full implementation of e-FCL, reduced paper usage and volume in version of forms submitted. This is a reinstatement with change of a collection previously approved by OMB.

---

Annual Cost to Federal Government: $459,607

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

---

Common Form ICR:  No

---

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: 07/25/2016

---