Information Collection

Security

IC 23402 under ICR 202110-1910-006 · OMB 1910-1800.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1910-1800 can be found here:

2023-08-10 - Revision of a currently approved collection

Documents and Forms

Document Name Document Type
Form DOE F 5631.34 Security Form and Instruction
FACTS Screen Shots.pdf Other-FACTS Screenshot
FACTS Screen Shots.pdf Other-FACTS Screenshot
DOE F 5631.34 Data Report on Spouse Cohabitant DOE F 5631 34 Data Report on Spouse Cohabitant 10-2021.pdf Form and Instruction
DOE F 5631.34 Data Report on Spouse Cohabitant DOE F 5631 34 Data Report on Spouse Cohabitant 10-2021.pdf Form and Instruction
DOE F 5631.5 The Conduct of Personnel Security Interviews DOE F 5631.5 The Conduct of Personnel Security Interviews 10-2021.pdf Form and Instruction
DOE F 5631.5 The Conduct of Personnel Security Interviews DOE F 5631.5 The Conduct of Personnel Security Interviews 10-2021.pdf Form and Instruction
DOE F 5631.18 Security Acknowledgement DOE F 5631.18 Security Acknowledgement 10-2021.pdf Form and Instruction
DOE F 5631.18 Security Acknowledgement DOE F 5631.18 Security Acknowledgement 10-2021.pdf Form and Instruction
DOE F 5631.20 Request for Visit or Access Approval DOE F 5631.20 Request for Visit or Access Approval 10-2021.pdf Form
DOE F 5631.20 Request for Visit or Access Approval DOE F 5631.20 Request for Visit or Access Approval 10-2021.pdf Form
DOE F 5639.3 Report of Security Incident/Infraction DOE F 5639.3 Report of Security Incident - Infraction 10-2021.pdf Form
DOE F 5639.3 Report of Security Incident/Infraction DOE F 5639.3 Report of Security Incident - Infraction 10-2021.pdf Form
DOE F 473.2 Badge Request Electronic DOE F 473.2 Badge Request Electronic 10-2021.pdf Form and Instruction
DOE F 473.2 Badge Request Electronic DOE F 473.2 Badge Request Electronic 10-2021.pdf Form and Instruction
DOE F 472.3 Foreign Citizenship Acknowledgement DOE F 472.3 Foreign Citizenship Acknowledgement 10-2021.pdf Form
DOE F 472.3 Foreign Citizenship Acknowledgement DOE F 472.3 Foreign Citizenship Acknowledgement 10-2021.pdf Form
DOE F 471.1 Security Incident Notification Report DOE F 471.1 Security Incident Notification Report 10-2021.pdf Form and Instruction
DOE F 471.1 Security Incident Notification Report DOE F 471.1 Security Incident Notification Report 10-2021.pdf Form and Instruction
DOE F 5631.29 Security Termination Statement DOE F 5631.29 Security Termination Statement 10-2021.pdf Form
DOE F 5631.29 Security Termination Statement DOE F 5631.29 Security Termination Statement 10-2021.pdf Form
Standard Form 328 Certificate Pertaining to Foreign Interests OMB 1910-1800 SF-328.pdf Form
Standard Form 328 Certificate Pertaining to Foreign Interests OMB 1910-1800 SF-328.pdf Form
DOE F 473.3 Clearance Access Request DOE F 473.3 Clearance Access Request.pdf Form and Instruction
DOE F 473.3 Clearance Access Request DOE F 473.3 Clearance Access Request.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Security	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DOE F 5631.34	Data Report on Spouse Cohabitant	DOE F 5631 34 Data Report on Spouse Cohabitant 10-2021.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	DOE F 5631.5	The Conduct of Personnel Security Interviews	DOE F 5631.5 The Conduct of Personnel Security Interviews 10-2021.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	DOE F 5631.18	Security Acknowledgement	DOE F 5631.18 Security Acknowledgement 10-2021.pdf	Yes	Yes	Fillable Fileable Signable
Form	DOE F 5631.20	Request for Visit or Access Approval	DOE F 5631.20 Request for Visit or Access Approval 10-2021.pdf	Yes	Yes	Fillable Fileable Signable
Form	DOE F 5639.3	Report of Security Incident/Infraction	DOE F 5639.3 Report of Security Incident - Infraction 10-2021.pdf	Yes	Yes	Fillable Fileable Signable
Other-FACTS Screenshot			FACTS Screen Shots.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	DOE F 473.2	Badge Request Electronic	DOE F 473.2 Badge Request Electronic 10-2021.pdf	Yes	Yes	Fillable Fileable
Form	DOE F 472.3	Foreign Citizenship Acknowledgement	DOE F 472.3 Foreign Citizenship Acknowledgement 10-2021.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	DOE F 471.1	Security Incident Notification Report	DOE F 471.1 Security Incident Notification Report 10-2021.pdf	Yes	Yes	Fillable Fileable
Form	DOE F 5631.29	Security Termination Statement	DOE F 5631.29 Security Termination Statement 10-2021.pdf	Yes	Yes	Fillable Fileable Signable
Form	Standard Form 328	Certificate Pertaining to Foreign Interests	OMB 1910-1800 SF-328.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	DOE F 473.3	Clearance Access Request	DOE F 473.3 Clearance Access Request.pdf	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: International Affairs and Commerce

Subfunction: Foreign Affairs

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 75,661	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 83 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	84,621	-2,272	86,893
Annual IC Time Burden (Hours)	13,251	1,955	11,296
Annual IC Cost Burden (Dollars)	1,192,590	-145,800	1,338,390

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.