Information Collection

Security

IC 23402 under ICR 201804-1910-001 · OMB 1910-1800.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1910-1800 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DOE F 471-1 Security	Form
OMB 1910-1800 FACTS Visit-Assignment Entry.docx	Other-Website
DOE F 471-1 Security Incident Notification Report OMB 1910-1800 DOE F 471.1 Security Incident Notification Report.pdf	Form
DOE F 472.3 Foreign Citizenship Ack OMB 1910-1800 DOE F 472.3 Foreign Citizenship Ack.pdf	Form
DOE F 473.2 Badge Reqeust OMB 1910-1800 DOE F 473.2 Badge Reqeust.pdf	Form
DOe F 473.3 Clearance Access Request OMB 1910-1800 DOE F 473.3 Clearance Access Request.pdf	Form
DOE F 5631.18 Security Acknowledgement OMB 1910-1800 DOE F 5631.18 Security Acknowledgement.pdf	Form
DOE F 5631.20 Request for Visit OMB 1910-1800 DOE F 5631.20 Request for Visit.pdf	Form
DOE F 5631.29 Security Termination OMB 1910-1800 DOE F 5631.29 Security Termination.pdf	Form
DOE F 5631.34 Data Report on Spouse Cohabitant OMB 1910-1800 DOE F 5631.34 Data Report on Spouse Cohabitant.pdf	Form
DOE F 5631.5 Security Interviews OMB 1910-1800 DOE F 5631.5 Security Interviews.pdf	Form
DOE F 5639.3 Report of Security Incident OMB 1910-1800 DOE F 5639.3 Report of Security Incident.pdf	Form

IC Title:

Security

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DOE F 471-1	Security Incident Notification Report	OMB 1910-1800 DOE F 471.1 Security Incident Notification Report.pdf	Yes	Yes	Fillable Fileable
Form	DOE F 472.3	Foreign Citizenship Ack	OMB 1910-1800 DOE F 472.3 Foreign Citizenship Ack.pdf	Yes	Yes	Fillable Fileable Signable
Form	DOE F 473.2	Badge Reqeust	OMB 1910-1800 DOE F 473.2 Badge Reqeust.pdf	Yes	Yes	Paper Only
Form	DOe F 473.3	Clearance Access Request	OMB 1910-1800 DOE F 473.3 Clearance Access Request.pdf	Yes	Yes	Fillable Fileable
Form	DOE F 5631.18	Security Acknowledgement	OMB 1910-1800 DOE F 5631.18 Security Acknowledgement.pdf	Yes	Yes	Fillable Fileable Signable
Form	DOE F 5631.20	Request for Visit	OMB 1910-1800 DOE F 5631.20 Request for Visit.pdf	Yes	Yes	Fillable Fileable
Form	DOE F 5631.29	Security Termination	OMB 1910-1800 DOE F 5631.29 Security Termination.pdf	Yes	Yes	Fillable Fileable Signable
Form	DOE F 5631.34	Data Report on Spouse Cohabitant	OMB 1910-1800 DOE F 5631.34 Data Report on Spouse Cohabitant.pdf	Yes	Yes	Fillable Fileable Signable
Form	DOE F 5631.5	Security Interviews	OMB 1910-1800 DOE F 5631.5 Security Interviews.pdf	Yes	Yes	Fillable Fileable Signable
Form	DOE F 5639.3	Report of Security Incident	OMB 1910-1800 DOE F 5639.3 Report of Security Incident.pdf	Yes	Yes	Fillable Fileable
Other-Website			OMB 1910-1800 FACTS Visit-Assignment Entry.docx	Yes	Yes	Fillable Fileable Signable

Line of Business: International Affairs and Commerce

Subfunction: Foreign Affairs

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 86,893

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 97 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	86,893	0	5,224	81,669
Annual IC Time Burden (Hours)	11,296	0	-59,910	71,206
Annual IC Cost Burden (Dollars)	1,338,390	1,338,390	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.