Security

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DOE F 473.3 Clearance Access Request	Form and Instruction	Modified	Available
Form Standard Form 328 Certificate Pertaining to Foreign Interests	Form	Modified	Available
Form DOE F 5631.29 Security Termination Statement	Form	Modified	Available
Form DOE F 471.1 Security Incident Notification Report	Form and Instruction	Modified	Available
Form DOE F 472.3 Foreign Citizenship Acknowledgement	Form	Modified	Available
Form DOE F 473.2 Badge Request Electronic	Form and Instruction	Modified	Available
Form DOE F 5639.3 Report of Security Incident/Infraction	Form	Modified	Available
Form DOE F 5631.20 Request for Visit or Access Approval	Form	Modified	Available
Form DOE F 5631.18 Security Acknowledgement	Form and Instruction	Modified	Available
Form DOE F 5631.5 The Conduct of Personnel Security Interviews	Form and Instruction	Modified	Available
Form DOE F 5631.34 Data Report on Spouse Cohabitant	Form and Instruction	Modified	Available
Form DOE F 5631.34 Security	Form and Instruction	Modified	Repair queued
30 Day FRN.pdf	Supplementary Document	Uploaded 2021-10-26	Repair queued
60 Day FRN - 081021.pdf	Supplementary Document	Uploaded 2021-10-26	Repair queued
1910-1800 Supporting Statement.docx	Supporting Statement A	Uploaded 2021-10-28	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
23402	Security	Form and Instruction	Modified	Clearance Access Request
23402	Security	Form	Modified	Certificate Pertaining to Foreign Interests
23402	Security	Form	Modified	Security Termination Statement
23402	Security	Form and Instruction	Modified	Security Incident Notification Report
23402	Security	Form	Modified	Foreign Citizenship Acknowledgement
23402	Security	Form and Instruction	Modified	Badge Request Electronic
23402	Security	Form	Modified	Report of Security Incident/Infraction
23402	Security	Form	Modified	Request for Visit or Access Approval
23402	Security	Form and Instruction	Modified	Security Acknowledgement
23402	Security	Form and Instruction	Modified	The Conduct of Personnel Security Interviews
23402	Security	Form and Instruction	Modified	Data Report on Spouse Cohabitant
23402	Security	Form and Instruction	Modified
23402	Security	Other-FACTS Screenshot	Modified

ICR Details

OMB Control No: 1910-1800	ICR Reference No: 202110-1910-006
Status: Historical Active	Previous ICR Reference No: 201804-1910-001
Agency/Subagency: DOE/DOEOA	Agency Tracking No: Sandy Dentinger
Title: Security
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/03/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/29/2021
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is approved for three years.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2025	36 Months From Approved	06/30/2022
Responses	84,621	0	86,893
Time Burden (Hours)	13,251	0	11,296
Cost Burden (Dollars)	1,192,590	0	1,338,390

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Abstract: Collections are used by DOE management to exercise management oversight and control over management and operating (M&O) contractors of DOE's government-owned contractor-operated (GOCO) facilities and offsite contractors. The "oversight and control" function concerns ways in which DOE contractors provide goods and services to DOE organizations and activities in accordance with the therms of their contracts, government regulations, etc. Information is collected from DOE contractors and the public

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Authorizing Statute(s): PL: Pub.L. 95 - 91 214, 644, 646(a) Name of Law: Department of Energy Organization Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 43648	08/10/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 58647	10/22/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Security	DOE F 471.1, DOE F 5631.34, DOE F 5631.5, DOE F 5631.18, DOE F 5631.20, DOE F 5639.3, DOE F 473.3, DOE F 473.2, DOE F 472.3, DOE F 5631.29, Standard Form 328	Data Report on Spouse Cohabitant ,   The Conduct of Personnel Security Interviews ,   Security Acknowledgement ,   Request for Visit or Access Approval ,   Report of Security Incident/Infraction ,   Badge Request Electronic ,   Foreign Citizenship Acknowledgement ,   Security Incident Notification Report ,   Security Termination Statement ,   Certificate Pertaining to Foreign Interests ,   Clearance Access Request

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ICR Summary of Burden

table that charts list of burden

	Total Approved	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	84,621	86,893	0	0	-2,272	0
Annual Time Burden (Hours)	13,251	11,296	0	0	1,955	0
Annual Cost Burden (Dollars)	1,192,590	1,338,390	0	0	-145,800	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $1,258,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 10/29/2021

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