Information Collection

NPPD Visitor Request Form

IC 229537 under ICR 202105-1670-004 · OMB 1670-0036.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1670-0036 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 11000-39 NPPD Visitor Request Form	Form and Instruction
11000-39 NPPD Visitor Request Form DHS Form 11000-39 - updated 4-27-17.pdf	Form and Instruction

IC Title:

NPPD Visitor Request Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

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	11000-39	NPPD Visitor Request Form	DHS Form 11000-39 - updated 4-27-17.pdf		Yes	Yes	Fillable Fileable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records

Title: DHS/ALL-023

FR Citation: 75 FR 8088

Number of Respondents: 20,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	-20,000	20,000
Annual IC Time Burden (Hours)	-3,333	3,333
Annual IC Cost Burden (Dollars)	0	0

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.