Interest Sheet

OMB Control Number: 1670-0031
OMB Expiration Date: xx/xx/xxxx

Office for Bombing Prevention – Event Sign-In Sheet
NAME

EMAIL ADDRESS

ORGANIZATION

TITLE/ROLE

I am interested in
connecting about:

Privacy Notice:
Authority: 5 U.S.C. § 301 and 44 U.S.C. § 3101 authorize the collection of this information.
Purpose: DHS/CISA Office for Bombing Prevention (OBP) will use this information to contact you periodically regarding updated materials and awareness product information.
Routine Uses: The information collected will be used by and disclosed to DHS personnel, contractors to assist in activities related to DHS OBP product and office outreach.
Disclosure: Providing this information is voluntary. Contact information submitted via the conference sign-up sheet will be used to contact you regarding updated or new OBP products.
PAPERWORK REDUCTION ACT: The public reporting burden to complete this information collection is estimated at 6 minutes per response, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and the completing and reviewing the collected information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it
displays a currently valid OMB control number and expiration date. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to
DHS/CISA/ISD /OBP, 245 Murray Lane SW., Mail Stop 0612, Washington, DC 20528–0612 or [email protected]. ATTN: 1670-0031.