Security

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DOE F 470.11 Electronic DOE Integrated Security System (eDISS+) Access Request	Form	Modified	Repair queued
Form DOE F 472.2 Mental Health Evaluation Consent	Form	Modified	Repair queued
Form DOE F 206.4 Information Sheet for Sponsorship of HSPD-12	Form	Modified	Repair queued
Form DOE F 473.4 Federal or Contractor BAO Termination	Form	Modified	Repair queued
Form DOE F 473.7 Other Government Agency Clearance Action Request	Form	Modified	Repair queued
Form DOE F 473.3 Clearance Access Request	Form and Instruction	Modified	Repair queued
Form Standard Form 328 Certificate Pertaining to Foreign Interests	Form	Modified	Available
Form DOE F 472.12 Security Termination Statement	Form	Modified	Repair queued
Form DOE F 471.1 Security Incident Notification Report	Form and Instruction	Modified	Repair queued
Form DOE F 473.2 Badge Request Electronic	Form and Instruction	Modified	Repair queued
Form DOE F 473.8 Report of Security Incident	Form	Modified	Repair queued
Form DOE F 473.6 Request for Visit or Access Approval	Form	Modified	Repair queued
Form DOE F 472.11 Security Acknowledgement	Form and Instruction	Modified	Repair queued
Form DOE F 272.2 Personnel Security Information Report	Form and Instruction	Modified	Repair queued
Form DOE F 5631.34 Security	Form and Instruction	Modified	Repair queued
OMB 1910-1800 Supporting Statement Final 2023 (FINAL 8.1.2023).docx	Supporting Statement A	Uploaded 2023-08-02	Repair queued
60-day FRN (12-12-2022).pdf	Supplementary Document	Uploaded 2023-06-12	Repair queued
30-day FRN (3-21-23).pdf	Supplementary Document	Uploaded 2023-06-12	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
23402	Security	Form	Modified	Electronic DOE Integrated Security System (eDISS+) Access Request
23402	Security	Form	Modified	Mental Health Evaluation Consent
23402	Security	Form	Modified	Information Sheet for Sponsorship of HSPD-12
23402	Security	Form	Modified	Federal or Contractor BAO Termination
23402	Security	Form	Modified	Other Government Agency Clearance Action Request
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 and Instruction	Modified	Badge Request Electronic
23402	Security	Form	Modified	Report of Security Incident
23402	Security	Form	Modified	Request for Visit or Access Approval
23402	Security	Form and Instruction	Modified	Security Acknowledgement
23402	Security	Form and Instruction	Modified	Personnel Security Information Report
23402	Security	Form and Instruction	Modified
23402	Security	Other-FACTS Screenshot	Modified

ICR Details

OMB Control No: 1910-1800	ICR Reference No: 202305-1910-004
Status: Active	Previous ICR Reference No: 202110-1910-006
Agency/Subagency: DOE/DOEOA	Agency Tracking No: Baldev Dhillon
Title: Security
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 12/19/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/10/2023
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is approved.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2027	36 Months From Approved	06/30/2025
Responses	104,556	0	84,621
Time Burden (Hours)	21,864	0	13,251
Cost Burden (Dollars)	1,970,302	0	1,192,590

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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:
	87 FR 76031	12/12/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 16963	03/21/2023
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 272.2, DOE F 472.11, DOE F 473.6, DOE F 473.8, DOE F 473.3, DOE F 473.2, DOE F 472.12, Standard Form 328, DOE F 470.11, DOE F 472.2 , DOE F 473.7, DOE F 473.4, DOE F 206.4	Personnel Security Information Report ,   Security Acknowledgement ,   Request for Visit or Access Approval ,   Report of Security Incident ,   Badge Request Electronic ,   Security Incident Notification Report ,   Security Termination Statement ,   Certificate Pertaining to Foreign Interests ,   Clearance Access Request ,   Other Government Agency Clearance Action Request ,   Federal or Contractor BAO Termination ,   Information Sheet for Sponsorship of HSPD-12 ,   Mental Health Evaluation Consent ,   Electronic DOE Integrated Security System (eDISS+) 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	104,556	84,621	0	19,935	0	0
Annual Time Burden (Hours)	21,864	13,251	0	8,613	0	0
Annual Cost Burden (Dollars)	1,970,302	1,192,590	0	777,712	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: Burden increase is due to the addition of a new form. U.S. Department of Energy Personnel Security Reporting Form (DOE F 272.2) was not originally included in the Information Collection that was approved with an expiration date of 6/30/2025. In accordance with Security Executive Agent Directive (SEAD) 3, Reporting Requirements for Personnel with Access to Classified Information or Who Hold a Sensitive Position, all covered individuals incur a special and continuing security obligation to be aware of the risks associated with foreign intelligence operations and/or possible terrorist activities directed against them in the United States and abroad. These individuals also have a responsibility to recognize and avoid personal behaviors and activities that may adversely impact their continued national security eligibility. Covered individuals shall report to their agency head or designee any planned or actual involvement in any of the activities outlined in the SEAD prior to participation in such activities or otherwise as soon as possible following the start of their involvement. The Department has a cleared population of approximately 100,000 and all are required to report on activities including arrest, foreign activities, name changes, association with foreign nationals, elicitation or attempted elicitation, mental health, unofficial foreign travel (planned and completed), contact with foreign intelligence, family residing in a sensitive country, drug/alcohol involvement, marriage/cohabitation, financial anomalies, and contact with the media. Under the Continuous Vetting Process outlined in Trusted Workforce 2.0 and SEAD 3, each Cognizant Personnel Security Office collects this information for review, investigation by the Defense Counterintelligence and Security Agency (as necessary), and adjudication to determine if a cleared individual continues to meet the requirements for holding a security clearance or a favorable access determination.

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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: 08/10/2023

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