Information Collection

Technical Assistance (TA) Evaluation Form - 9042

IC 197202 under ICR 202309-1670-002 · OMB 1670-0023.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DHS Form 9042 Technical Assistance (TA) Evaluation Form - 9042	Form and Instruction
DHS Form 9042 CISA Technical Assistance (TA) Evaluation Form CISA_Technical_Assistance_Evaluation_Form_7_2020.pdf	Form and Instruction
DHS Form 9042 CISA Technical Assistance (TA) Evaluation Form CISA_Technical_Assistance_Evaluation_Form_7_2020.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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 Form 9042	CISA Technical Assistance (TA) Evaluation Form	CISA_Technical_Assistance_Evaluation_Form_7_2020.pdf		Yes	Yes	Fillable Fileable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records

Title: Department of Homeland Security Mailing and Other Lists System of Records

FR Citation: 73 FR 71659

Number of Respondents: 128

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	128	128
Annual IC Time Burden (Hours)	11	11
Annual IC Cost Burden (Dollars)	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.