Information Collection

Personal Identity Verification (PIV) & Pre-Security Form

IC 248944 under ICR 202107-2501-002 · OMB 2501-0038.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2501-0038 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 22019 Personal Identity Verification (PIV) & Pre-Security Form	Form and Instruction
22019 PerSIST PIV Form FINAL- PIV form 22019-OCHCO-HCISD.docx	Form and Instruction
22019 PerSIST PIV Form FINAL- PIV form 22019-OCHCO-HCISD.docx	Form and Instruction

IC Title:

Personal Identity Verification (PIV) & Pre-Security Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

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	22019	PerSIST PIV Form	FINAL- PIV form 22019-OCHCO-HCISD.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title: PerSIST

FR Citation: 83 FR 22094

Number of Respondents: 1,625

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,625	1,625
Annual IC Time Burden (Hours)	276	276
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.