Information Collection

Personnel Security Data Form- Employee

IC 236447 under ICR 201909-3133-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Personnel Security Data Form- Employee	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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:

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 %

	Approved	Previously Approved
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

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.