Information Collection

Security

IC 23402 under ICR 202305-1910-004 · OMB 1910-1800.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form DOE F 5631.34
Security
Form and Instruction
Form DOE F 272.2
Personnel Security Information Report Security
Form and Instruction
Form DOE F 472.11
Security Acknowledgement Security
Form and Instruction
Form DOE F 473.6
Request for Visit or Access Approval Security
Form
Form DOE F 473.8
Report of Security Incident Security
Form
Form DOE F 473.2
Badge Request Electronic Security
Form and Instruction
Form DOE F 471.1
Security Incident Notification Report Security
Form and Instruction
Form DOE F 472.12
Security Termination Statement Security
Form
Form Standard Form 328
Certificate Pertaining to Foreign Interests Security
Form
Form DOE F 473.3
Clearance Access Request Security
Form and Instruction
Form DOE F 473.7
Other Government Agency Clearance Action Request Security
Form
Form DOE F 473.4
Federal or Contractor BAO Termination Security
Form
Form DOE F 206.4
Information Sheet for Sponsorship of HSPD-12 Security
Form
Form DOE F 472.2
Mental Health Evaluation Consent Security
Form
Form DOE F 470.11
Electronic DOE Integrated Security System (eDISS+) Access Request Security
Form
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 272.2 Personnel Security Information Report
DOE F 272.2 Personnel Security Information Report.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 472.11 Security Acknowledgement
DOE F 472.11 - Security Acknowledgment.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 473.6 Request for Visit or Access Approval
DOE F 473.6 Request for Visitor Access Approval.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 473.8 Report of Security Incident
DOE F 473.8 Report of Security Incident.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 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 472.12 Security Termination Statement
DOE F 472.12 Security Termination.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 Security Clearance Access.pdf
Form and Instruction
DOE F 272.2 Personnel Security Information Reporting Form
DOE F 272.2 - Personnel Security Information Reporting Form (fillable) - October 2022.pdf
Form and Instruction
DOE F 473.7 Other Government Agency Clearance Action Request
DOE F 473.7 Other Government Agency Clearance Action Request.pdf
Form
DOE F 473.4 Federal or Contractor BAO Termination
DOE F 473.4 Federal or Contractor Building Access Only (BAO) Termination.pdf
Form
DOE F 206.4 Information Sheet for Sponsorship of HSPD-12
DOE F 206.4 Information Sheet for Sponsorship of HSPD-12 Credential.pdf
Form
DOE F 472.2 Mental Health Evaluation Consent
DOE F 472.2 Mental Health Evaluation Consent.pdf
Form
DOE F 470.11 Electronic DOE Integrated Security System (eDISS+) Acces
DOE F 470.11 eDISS Access Request.pdf
Form

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 DOE F 272.2 Yes Yes Fillable Fileable Signable
Form and Instruction DOE F 472.11 Yes Yes Fillable Fileable Signable
Form DOE F 473.6 Yes Yes Fillable Fileable Signable
Form DOE F 473.8 Yes Yes Fillable Fileable Signable
Other-FACTS Screenshot Yes Yes Fillable Fileable
Form and Instruction DOE F 473.2 Yes Yes Fillable Fileable
Form and Instruction DOE F 471.1 Yes Yes Fillable Fileable
Form DOE F 472.12 Yes Yes Fillable Fileable Signable
Form Standard Form 328 Yes Yes Fillable Fileable Signable
Form and Instruction DOE F 473.3 Yes Yes Fillable Fileable
Form DOE F 473.7 Yes Yes Fillable Fileable
Form DOE F 473.4 Yes Yes Fillable Fileable
Form DOE F 206.4 Yes Yes Fillable Fileable
Form DOE F 472.2 Yes Yes Fillable Fileable
Form DOE F 470.11 Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 104,556 0 19,935 0 0 84,621
Annual IC Time Burden (Hours) 21,864 0 8,613 0 0 13,251
Annual IC Cost Burden (Dollars) 1,970,302 0 777,712 0 0 1,192,590

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.
Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].