CISA Speaker Request Form

ICR 202105-1670-002


Federal Form Document

IC Document Collections
247259 New
ICR Details
Received in OIRA
CISA Speaker Request Form
New collection (Request for a new OMB Control Number)   No
Regular 06/09/2021
  Requested Previously Approved
36 Months From Approved
1,300 0
325 0
0 0

The Speaker Request Form will be the first point of contact between CISA and the public to initiate CISA speaking engagements. The form will be available on and any member of the public can submit a request for a CISA employee to speak at an event. The form will be used by CISA to track and manage external speaking engagements. The information will be used to schedule and determine the most appropriate CISA speaker based on date, time, location, presentation format, and topic. The form collects information about the event, discussion topics, presentation format, media participation, disclosures, special event guest, and event coordinator information. Information from the Speaker Request Form regarding the requested speaking engagement, the host organization, the speaking topic, agenda and additional event details will be collected. The requested information helps CISA determine whether the speaker should attend the engagement and/or how CISA should best prepare for the event. The information is used to determine if the event warrants the time and attention of the invited speaker and what messages and information can be shared on behalf of the Agency with a public or targeted audience. The CISA Speakers Bureau team will use the information to identify a speaker and route the Speakers Request Form to that person for consideration. The information is then sent to DHS Public Affairs for awareness of CISA speaking engagements.

PL: Pub.L. 115 - 278 2201 Name of Law: Cybersecurity and Infrastructure Security Agency Act, 2018
   PL: Pub.L. 107 - 296 101 Name of Law: Homeland Security Act, 2002
   PL: Pub.L. 104 - 13 3501 Name of Law: Paperwork Reduction Act, 1995
   PL: Pub.L. 114 - 185 552 Name of Law: FOIA Improvement Act, 2016

Not associated with rulemaking

  85 FR 82497 12/18/2020
86 FR 15493 03/23/2021

IC Title Form No. Form Name
CISA Speaker Request Form n//a CISA Speaker Request Form

  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 1,300 0 0 1,300 0 0
Annual Time Burden (Hours) 325 0 0 325 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Miscellaneous Actions
This is a NEW collection.

Mia Bruce 202 357-8441 [email protected]


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:
    (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;
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.

© 2021 | Privacy Policy