Information Collection

State, Local, Tribal and Private Sector Clearance Request Form

IC 214622 under ICR 202304-1670-003 · OMB 1670-0013.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DHS 9014 State, Local, Tribal and Private Sector Clearance Request Form	Form and Instruction
DHS 9014 PRIVATE SECTOR CLEARANCE PROGRAM REQUEST 1670-0013_PSCP_DHS Form 9014_CISA_protected.pdf	Form and Instruction
DHS 9014 PRIVATE SECTOR CLEARANCE PROGRAM REQUEST 1670-0013_PSCP_DHS Form 9014_CISA_protected.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	DHS 9014	PRIVATE SECTOR CLEARANCE PROGRAM REQUEST	1670-0013_PSCP_DHS Form 9014_CISA_protected.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records

Title: Department of Homeland Security/ALL--023 Personnel Security Management System of Records

FR Citation: 75 FR 8088

Number of Respondents: 550

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	550	-110	660
Annual IC Time Burden (Hours)	92	-18	110
Annual IC Cost Burden (Dollars)	0	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.