Incident Reporting Form

CISA Reporting Forms

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1670-0037 can be found here:

Documents and Forms

Document Name Document Type
Incident Reporting Form Form and Instruction
Incident Reporting Form Incident Reporting Form.docx us-cert.cisa.gov/forms/report Form and Instruction

Information Collection (IC) Details

IC Title:	Incident Reporting Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N/A	Incident Reporting Form	Incident Reporting Form.docx	https://us-cert.cisa.gov/forms/report	Yes	Yes	Fillable Fileable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 26,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	26,000	4,000	22,000
Annual IC Time Burden (Hours)	8,667	7,567	1,100
Annual IC Cost Burden (Dollars)	0	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.