OMB.report

Federal forms, ICRs, and supporting documents

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
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 5631.5 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 5631.20 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 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 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
DOE F 473.3 Clearance Access Request
DOE F 473.3 Clearance Access Request.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

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 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
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 Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Requested 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 109,621 0 25,000 0 0 84,621
Annual IC Time Burden (Hours) 25,751 0 12,500 0 0 13,251
Annual IC Cost Burden (Dollars) 2,317,590 0 1,125,000 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.