Information Collection

CCSF Applications

IC 189821 under ICR 201906-1652-004 · OMB 1652-0053.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1652-0053 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form TSA Form 419a CCSF Applications	Form and Instruction
TSA Form 419B CCSF Facility Profile Application TSA Form 419B, FINAL, 7.9.2019.docx	Form and Instruction
TSA Form 419D CCSF Principal Attestation TSA_Form_419D_CCSF_Principal_Attestation 7.9.2019.doc	Form and Instruction
TSA Form 419a CCSF Letter of Intent TSA form 419A reviewed 7.9.2019.docx	Form and Instruction
DHS 11000-6 Non-Disclosure Agreement NDA-2018_PRA.pdf	Form and Instruction

IC Title:

CCSF Applications

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 49 CFR 1549.7

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 and Instruction	TSA Form 419a	CCSF Letter of Intent	TSA form 419A reviewed 7.9.2019.docx	Yes	Yes	Fillable Fileable
Form and Instruction	DHS 11000-6	Non-Disclosure Agreement	NDA-2018_PRA.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	TSA Form 419B	CCSF Facility Profile Application	TSA Form 419B, FINAL, 7.9.2019.docx	Yes	Yes	Fillable Fileable
Form and Instruction	TSA Form 419D	CCSF Principal Attestation	TSA_Form_419D_CCSF_Principal_Attestation 7.9.2019.doc	Yes	Yes	Fillable Fileable

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	180	180
Annual IC Cost Burden (Dollars)	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.