Information Collection

USDA PIV Request for Credential

IC 985 under ICR 202305-0505-001 · OMB 0505-0022.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form AD-1197 USDA PIV Request for Credential	Form
AD-1197 Request for USDA Identification (ID) Badge AD-1197_v2_OMB copy_NoPassword_20200520_ (003).pdf	Form
AD-1197 Request for USDA Identification (ID) Badge 20230614_AD1197_OMB submission_508.pdf	Form
DM 4620-002.pdf DM 4620-002	IC Document
DM 4620-002.pdf DM 4620-002	IC Document
DR 4620-002.pdf DR 4620-002	IC Document
DR 4620-002.pdf DR 4620-002	IC Document

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	AD-1197	Request for USDA Identification (ID) Badge	20230614_AD1197_OMB submission_508.pdf		Yes	No	Fillable Printable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records

Title: USDA/OSSP-1, Enterprise Physical Access Control System

FR Citation: 88 FR 36272

Number of Respondents: 3,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,000	-9,000	12,000
Annual IC Time Burden (Hours)	3,000	-21,000	24,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
DM 4620-002	DM 4620-002.pdf	05/31/2023
DR 4620-002	DR 4620-002.pdf	05/31/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.