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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

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	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 %

table that charts list of burden
	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

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.