Information Collection

SAFECOM Membership Questionnaire

IC 247241 under ICR 202105-1670-001 · OMB 1670-0046.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1670-0046 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1670-00XX SAFECOM Membership Questionnaire	Form and Instruction
1670-00XX SAFECOM Membership Questionnaire 1670-NEW_SAFECOM Membership Questionnaire_FORM_PRE APPROVED (7-MAY-2021).pdf	Form and Instruction

IC Title:

SAFECOM Membership Questionnaire

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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 and Instruction	1670-00XX	SAFECOM Membership Questionnaire	1670-NEW_SAFECOM Membership Questionnaire_FORM_PRE APPROVED (7-MAY-2021).pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	625	625

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.