Information Collection

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

IC 263420 under ICR 202311-1601-002 · OMB 1601-0038.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 11000-16 Personal Identity Verification Official (PIV-O) and Shield Request	Form and Instruction
11000-16 PIV-O Credential and Shield Request DHS11000-16-DHS PIV-O Credential and Shield Request-03062023 (clean).pdf	Form and Instruction
11000-16 PIV-O Credential and Shield Request DHS11000-16-DHS PIV-O Credential and Shield Request-03062023 (clean).pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

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	11000-16	PIV-O Credential and Shield Request	DHS11000-16-DHS PIV-O Credential and Shield Request-03062023 (clean).pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: General Government

Subfunction: Central Personnel

Privacy Act System of Records

Title: PIV Management System System of Records

FR Citation: 74 FR 30301

Number of Respondents: 1,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	375	375
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.