Facility Access Request

Forms and Documents

Document Name	Status
Form 121-3-1-3A Facility Access Request Form and Instruction	New
121-01-001.pdf Supplementary Document	2021-01-27
11005 Suspending Access to DHS Facilities, Sensitive Information, and IT Systems.pdf Supplementary Document	2021-01-27
m11-11.pdf Supplementary Document	2021-01-27
m05-24.pdf Supplementary Document	2021-01-27
CFR-2019-title41-vol3-sec102-74-555.pdf Supplementary Document	2021-01-27
CFR-2019-title44-vol1-sec15-3.pdf Supplementary Document	2021-01-27
CFR-2020-title6-vol1-sec37-23.pdf Supplementary Document	2021-01-27
ICR 1660-NW75 Published 30 Day FRN 5-18-2020.pdf Supplementary Document	2020-06-24
ICR 1660-NW75 Published 60 Day FRN 1-22-2020.pdf Supplementary Document	2020-06-24
Supporting Statement for ICR 1660-NW0075 6-24-2020 clean.docx Supporting Statement A	2020-06-24

IC Document Collections

IC ID	Document Title	Status
242405	Facility Access Request Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202006-1660-007
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: DHS/FEMA	Agency Tracking No:
Title: Facility Access Request
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 02/16/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	20,500	0
Time Burden (Hours)	3,485	0
Cost Burden (Dollars)	0	0

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Abstract: The purpose of the collection is for the Federal Emergency Management Agency (FEMA) to obtain information from all persons applying for access to any FEMA controlled facility through the use of two Facility Access Request forms: FEMA Form 121-3-1-3A and 121-3-1-3B. This information is used to create a profile in the Physical Access Control System (PACS). The collection of personally identifiable information (PII) is used to authenticate the identity of FEMA employees and contractors, and visitors who request and are granted entry authorization. FEMA uses this collected information to run an additional background check through the National Crime Information Center (NCIC). NCIC is a computerized database administered by the Federal Bureau of Investigation (FBI) that provides ready access to law enforcement agencies for making inquiries about an individual’s criminal history. This check verifies that an individual does not have any outstanding warrants for criminal activities indicating a risk to the Department of Homeland Security. This information collection is further used to contact individuals in the event of an emergency.

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Authorizing Statute(s): US Code: 18 USC 930 Name of Law: Possession of firearms and dangerous weapons in Federal
   US Code: 42 USC 5197a Name of Law: Security Regulations
   US Code: 40 USC 1315 Name of Law: Law Enforcement Authority of Secretary of Homeland Security for Protection of Public Property
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 3712	01/22/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 29733	05/18/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Facility Access Request	121-3-1-3A, 121-3-1-3B	Facility Access Request ,   Facility Access Request

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ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	20,500	0	0	20,500	0	0
Annual Time Burden (Hours)	3,485	0	0	3,485	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new collection.

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Annual Cost to Federal Government: $23,027

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/16/2021

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