Security

Forms and Documents

Document Name	Status
Form DOE F 471-1 Security Form	Modified
1910-1800 Details for ITEM 12 and 13 Supporting Statement 2017.xls Supplementary Document	2018-04-20
OMB 1910-1800 Supporting Statement 2018 Final.doc Supporting Statement A	2018-04-20

IC Document Collections

IC ID	Document Title	Status
23402	Security Form	Modified

ICR Details

OMB Control No: 1910-1800	ICR Reference No: 201804-1910-001
Status: Active	Previous ICR Reference No: 201203-1910-012
Agency/Subagency: DOE/DOEOA	Agency Tracking No: Sandy Dentinger
Title: Security
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: 10/29/2018
	Date Received in OIRA: 04/20/2018
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is approved for three years.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2021	36 Months From Approved
Responses	86,893	0	0
Time Burden (Hours)	11,296	0	0
Cost Burden (Dollars)	1,338,390	0	0

---

Abstract: Collections are used by DOE management to exercise management oversight and control over management and operating (M&O) contractors of DOE's government-owned contractor-operated (GOCO) facilities and offsite contractors. The "oversight and control" function concerns ways in which DOE contractors provide goods and services to DOE organizations and activities in accordance with the therms of their contracts, government regulations, etc. Information is collected from DOE contractors and the public

---

Authorizing Statute(s): PL: Pub.L. 95 - 91 214, 644, 646(a) Name of Law: Department of Energy Organization Act
  

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:
	82 FR 48806	10/20/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 61278	12/27/2017
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Security	DOE F 472.3, DOE F 5631.29, DOE F 5631.34, DOE F 473.2, DOE F 471-1, DOe F 473.3, DOE F 5631.18, DOE F 5631.20, DOE F 5631.5, DOE F 5639.3	Security Incident Notification Report ,   Foreign Citizenship Ack ,   Badge Reqeust ,   Clearance Access Request ,   Security Acknowledgement ,   Request for Visit ,   Security Termination ,   Data Report on Spouse Cohabitant ,   Security Interviews ,   Report of Security Incident

---

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	86,893	0	0	0	5,224	81,669
Annual Time Burden (Hours)	11,296	0	0	0	-59,910	71,206
Annual Cost Burden (Dollars)	1,338,390	0	0	1,338,390	0	0

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: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $578,000

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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: 04/20/2018

---