Personal Identity Verification Official (PIV-O) and Shield Request

Forms and Documents

Document Name	Status
Form 11000-16 Personal Identity Verification Official (PIV-O) and Shield Request Form and Instruction	New
Executive Order 13764.pdf Supplementary Document	2023-11-16
Executive Order 13764.pdf Supplementary Document	2023-11-16
Supporting Statement A (DHS Form 11000-16)_11.15.2023.docx Supporting Statement A	2023-11-16
60-Day FRN.pdf Supplementary Document	2023-11-06
30-Day FRN.pdf Supplementary Document	2023-11-06
SORN-DHS All-026 Personal Identity Verification.pdf Supplementary Document	2023-11-06
privacy-pia-dhs-all-piv-10-13-2006.pdf Supplementary Document	2023-11-06
OMB Form 83-I for DHS Form 11000-16 (v1.0 20230308) (002).pdf Supplementary Document	2023-11-06
Homeland Security Presidential Directive 12.pdf Supplementary Document	2023-11-06

IC Document Collections

IC ID	Document Title	Status
263420	Personal Identity Verification Official (PIV-O) and Shield Request Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202311-1601-002
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: DHS/OS	Agency Tracking No:
Title: Personal Identity Verification Official (PIV-O) and Shield Request
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: 11/16/2023

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	1,500	0
Time Burden (Hours)	375	0
Cost Burden (Dollars)	0	0

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Abstract: This collection of information, using Department of Homeland Security (DHS) Form 11000-16, is necessary to support Homeland Security Presidential Directive 12: Policy for a Common Identification Standard for Federal Employees and Contractors, issued on August 27, 2004, which mandates a federal standard for secure and reliable forms of identification. The collection is used in accordance with System of Record Notice DHS/ALL-026 Department of Homeland Security Personal Identity Verification Management System and Department policy to request a DHS Personal Identity Verification Official (PIV-O) credential, and if applicable, a shield (i.e., metallic law enforcement or non-law enforcement badge) to accompany the credential. A DHS PIV-O credential describes authorities delegated to specific DHS employees, contractors, and affiliates who interact with the public or federal, state, local, or tribal entities to perform authorized official functions pursuant to law, statute, regulation, or DHS Directive.

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Authorizing Statute(s): EO: EO 13764 Name/Subject of EO: Amending the Civil Service rules
   EO: EO 13467 Name/Subject of EO: Reforming Processes Related to Suitability for Government Employment
   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
Personal Identity Verification Official (PIV-O) and Shield Request	11000-16	PIV-O Credential and Shield Request

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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	1,500	0	0	0	1,500	0
Annual Time Burden (Hours)	375	0	0	0	375	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: 11/16/2023

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