Contractor Fitness/Security Screening Request Form

Forms and Documents

Document Name	Status
privacy_pia_dhswide_isms-2011.pdf Supplementary Document	2023-11-14
1600-0004 Contractor Fitness Security Screening SORN 85 FR 64511 11-12-2020.pdf Supplementary Document	2023-11-14
30 Day FRN 88 FR 73038 10-24-2023.pdf Supplementary Document	2023-11-06
60-Day FRN 88 FR 55469 8-15-2023.pdf Supplementary Document	2023-11-06
Homeland Security Presidential Directive 12.pdf Supplementary Document	2023-11-06
FAR 52.204-9.pdf Supplementary Document	2023-11-06
FAR 52.204-2.pdf Supplementary Document	2023-11-06
Executive Order 13764.pdf Supplementary Document	2023-11-06
Executive Order 13467.pdf Supplementary Document	2023-11-06
Executive Order 10577.pdf Supplementary Document	2023-11-06
Executive Order 9397.pdf Supplementary Document	2023-11-06
5 CFR Part 732.pdf Supplementary Document	2023-11-06
5 CFR Part 731.pdf Supplementary Document	2023-11-06
1601-NEW Contractor Fitness Security Screening Request Form SS_A (DHS Form 11000-25).docx Supporting Statement A	2023-11-15

IC Document Collections

IC ID	Document Title	Status
263396	Contractor Fitness/Security Screening Request Form DHS Form 11000-25	New

ICR Details

OMB Control No:	ICR Reference No: 202311-1601-001
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: DHS/OS	Agency Tracking No:
Title: Contractor Fitness/Security Screening Request Form
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 11/15/2023

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	45,000	0
Time Burden (Hours)	11,250	0
Cost Burden (Dollars)	0	0

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Abstract: This collection of information is necessary to initiate the contractor fitness screening process for determining whether a person (i.e., the respondent) who has been invited to perform work under a contract for, or on behalf of the Department of Homeland Security (DHS), should be deemed fit to perform such work and eligible for logical and/or physical access to DHS resources based on the risk levels of the designated position. The respondent is responsible for providing and/or verifying information to complete Section II of DHS Form 11000-25; the remaining sections of DHS Form 11000-25 (Sections I, III, and IV) are completed by DHS federal employees

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Authorizing Statute(s): EO: EO 13764 Name/Subject of EO: Presidential Documents
   EO: EO 10577 Name/Subject of EO: Amending the Civil Service Rules
   EO: EO 9397 Name/Subject of EO: Numbering System for Federal Accounts Relating to Individual Persons
  

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:
	88 FR 55467	08/15/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 73039	10/24/2023
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Contractor Fitness/Security Screening Request Form DHS Form 11000-25

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ICR Summary of Burden

	Total Request	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	45,000	0	0	0	45,000	0
Annual Time Burden (Hours)	11,250	0	0	0	11,250	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement: This is a new collection.

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Annual Cost to Federal Government: $0

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: 11/15/2023

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