Information Collection

Technical Assistance (TA) Evaluation Form - 9042

IC 197202 under ICR 201902-1670-001 · OMB 1670-0023.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1670-0023 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DHS Form 9042 Technical Assistance (TA) Evaluation Form - 9042	Form and Instruction
DHS Form 9042 Technical Assistance (TA) Evaluation Form DHS Form 9042.pdf www.dhs.gov/ictapscip-resources.	Form and Instruction

IC Title:

Technical Assistance (TA) Evaluation Form - 9042

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DHS Form 9042	Technical Assistance (TA) Evaluation Form	DHS Form 9042.pdf	https://www.dhs.gov/ictapscip-resources.	Yes	Yes	Fillable Fileable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records

Title: Department of Homeland Security Mailing and Other Lists System of Records

FR Citation: 73 FR 71659

Number of Respondents: 128

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	128	-1,872	2,000
Annual IC Time Burden (Hours)	11	-829	840
Annual IC Cost Burden (Dollars)	0	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.