Information Collection

White House Communications Agency Security Screening Questionnaire

IC 209218 under ICR 202107-0704-012 · OMB 0704-0507.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0507 can be found here:

Documents and Forms

Document Name Document Type
Form WHCA 89 White House Communications Agency Security Screening Questionnaire Form and Instruction
WHCA 89 White House Communications Agency Security Screening Que SSQ Fillable - WHCA Form 89_9.20.21 (002).pdf Form and Instruction
WHCA 89 White House Communications Agency Security Screening Que SSQ Fillable - WHCA Form 89_9.20.21 (002).pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	White House Communications Agency Security Screening Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	WHCA 89	White House Communications Agency Security Screening Questionaire (SSQ)	SSQ Fillable - WHCA Form 89_9.20.21 (002).pdf		Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	38	38
Annual IC Cost Burden (Dollars)	1,437	1,437

Documents for IC

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.