SAFECOM Membership Questionnaire

Forms and Documents

Document Name	Status
Form 1670-00XX SAFECOM Membership Questionnaire Form and Instruction	New
PLAW-104-13 - Paperwork Reduction Act, 1995.pdf Supplementary Document	2021-05-07
1670-NEW_SAFECOM Membership Questionnaire_FORM_PRE APPROVED (7-MAY-2021).pdf Supplementary Document	2021-05-07
PLAW-109-295 - Department of Homeland Security Appropriations Act, 2007.pdf Supplementary Document	2021-05-07
PLAW-107-296 - Homeland Security Act, 2002.pdf Supplementary Document	2021-05-07
PLAW 115-278 Section 2201- Cybersecurity and Infrastructure Security Agency Act, 2018.pdf Supplementary Document	2021-05-07
PIA_DHS-ALL-061 - HSIN 3.0 Shared Spaces On The Sensitive But Unclassified Network.pdf Supplementary Document	2021-05-07
PIA_DHS-ALL-006 - DHS General Contact Lists.pdf Supplementary Document	2021-05-07
DHS-ALL–002 - Department of Homeland Security (DHS) Mailing and Other Lists System.pdf Supplementary Document	2021-05-07
DHS-ALL–004 - General Information Technology Access Account Records System of Records (GITAARS).pdf Supplementary Document	2021-05-07
6 USC 652 - Cybersecurity and Infrastructure Security Agency.pdf Supplementary Document	2021-05-07
6 USC 571 - Office of Emergency Communications.pdf Supplementary Document	2021-05-07
PUBL 30-Day FRN--86 No. 54 FR 15488 on 20210323.pdf Supplementary Document	2021-05-07
PUBL 60-Day FRN--85 No. 187 FR 60483 on 09252020.pdf Supplementary Document	2021-05-07
1670-NEW_SAFECOM Membership Questionnaire_SSB_FINAL (7-MAY-2021).docx Supporting Statement B	2021-05-07
1670-NEW_SAFECOM Membership Questionnaire_SSA_FINAL (28-MAR-2021).docx Supporting Statement A	2021-05-07

IC Document Collections

IC ID	Document Title	Status
247241	SAFECOM Membership Questionnaire Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202105-1670-001
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: DHS/CISA	Agency Tracking No:
Title: SAFECOM Membership Questionnaire
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: 06/09/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	50	0
Time Burden (Hours)	13	0
Cost Burden (Dollars)	625	0

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Abstract: The SAFECOM Membership Questionnaire is an internal SAFECOM document disseminated only to active SAFECOM Members. SAFECOM uses the Questionnaire to identify membership gaps, obtain updated information on SAFECOM’s membership body (e.g., public safety communications experience, accolades, acquired skills/certifications, etc.), update SAFECOM marketing materials, and to assist SAFECOM when responding General Accounting Office (GAO) inquiries. The Questionnaire will encompass eight interdependent sections of questions. The SAFECOM Internal Membership section requests each Member to provide their name, state of residence, and the number of hours per month he/she contributes SAFECOM led initiatives (e.g., conference calls and deliverable development). SAFECOM consists of public safety association representatives and at-large members. The Association Representative Information section pertains to public safety associations represented in SAFECOM. Association Representatives serving in SAFECOM are asked to provide the name of their Association, approximate Association size, Association contact, and addition Association point-of-contact (POC) information. At-large members are instructed to skip to the next section. Public Safety Service section will focus on questions related to each Member’s public safety and first responder career. Members are asked to designate their current public safety status (i.e., active, retired, other), to identify their public safety discipline(s), to provide level of government for current employment (e.g., state, local, tribal, territorial, federal), to provide years of service, to list current agency and agency’s contact information, to provide a brief description on their current role and responsibilities, to select the population range that best describes the population of your current organization’s jurisdiction serviced, to indicate the number of public safety personnel employed at your current organization, to indicate the number of responses your current organization responds to each year, and if current position entails collaborating with Tribal Nations. The Volunteer Experience section asks Members to provide details on their volunteer experience. The Public Safety Experience section asks Members to identify the public safety events he/she responded to throughout their career, and to identify the communications technology he/she has used. The Education section focuses on the education (e.g., which is an optional question), proficiencies, and professional certifications. External Conference Attendance section focuses on Member’s experience at public safety conferences as well as their interest in representing SAFECOM in the future at a conference. The final section focuses on Members public safety usage.

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Authorizing Statute(s): PL: Pub.L. 104 - 13 3501 Name of Law: Paperwork Reduction Act, 1995
   PL: Pub.L. 115 - 278 2201 Name of Law: Homeland Security Act of 2002
   US Code: 6 USC 571 Name of Law: Office of Emergency Communications
   US Code: 6 USC 652 Name of Law: Cybersecurity and Infrastructure Agency
   PL: Pub.L. 107 - 296 101 Name of Law: Homeland Security Act, 2002
   PL: Pub.L. 109 - 295 1801 Name of Law: Department of Homeland Security Appropriations Act, 2007
  

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 60483	09/25/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 15488	03/23/2021
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
SAFECOM Membership Questionnaire	1670-00XX	SAFECOM Membership Questionnaire

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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	50	0	0	50	0	0
Annual Time Burden (Hours)	13	0	0	13	0	0
Annual Cost Burden (Dollars)	625	0	0	625	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: $984

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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: 06/09/2021

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