Information Collection

Personnel Security Data Form- Employee

IC 236447 under ICR 201906-3133-003 · OMB 3133-0201.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3133-0201 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1092 Personnel Security Data Form- Employee	Form
1092 Personnel Security Data Form- Employee 1092_NCUA EMPLOYEE DATA FORM OMB 05.2019.pdf	Form

IC Title:

Personnel Security Data Form- Employee

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 5 CFR Part 731 (To search for a specific CFR, visit the Code of Federal Regulations.)

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	1092	Personnel Security Data Form- Employee	1092_NCUA EMPLOYEE DATA FORM OMB 05.2019.pdf		Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title: Personnel Access and Security System (PASS),

FR Citation: 81 FR 12748

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	17	17
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.