Pta

Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

PRIVACY THRESHOLD ANALYSIS (PTA)
This form serves as the official determination by the DHS Privacy Office to
identify the privacy compliance requirements for all Departmental uses of
personally identifiable information (PII).
A Privacy Threshold Analysis (PTA) serves as the document used to identify
information technology (IT) systems, information collections/forms, technologies,
rulemakings, programs, information sharing arrangements, or pilot projects that involve
PII and other activities that otherwise impact the privacy of individuals as determined by
the Chief Privacy Officer, pursuant to Section 222 of the Homeland Security Act, and to
assess whether there is a need for additional Privacy Compliance Documentation. A PTA
includes a general description of the IT system, information collection, form, technology,
rulemaking, program, pilot project, information sharing arrangement, or other Department
activity and describes what PII is collected (and from whom) and how that information is
used and managed.
Please complete the attached Privacy Threshold Analysis and submit it to your
component Privacy Office. After review by your component Privacy Officer the PTA is sent
to the Department’s Senior Director for Privacy Compliance for action. If you do not have a
component Privacy Office, please send the PTA to the DHS Privacy Office:
Senior Director, Privacy Compliance
The Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
Tel: 202-343-1717
[email protected]
Upon receipt from your component Privacy Office, the DHS Privacy Office will review this
form and assess whether any privacy compliance documentation is required. If compliance
documentation is required – such as Privacy Impact Assessment (PIA), System of Records
Notice (SORN), Privacy Act Statement, or Computer Matching Agreement (CMA) – the DHS
Privacy Office or component Privacy Office will send you a copy of the relevant compliance
template to complete and return.

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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

Privacy Threshold Analysis (PTA)

Specialized Template for
Information Collections (IC) and Forms
The Forms-PTA is a specialized template for Information Collections and Forms. This
specialized PTA must accompany all Information Collections submitted as part of the
Paperwork Reduction Act process (any instrument for collection (form, survey,
questionnaire, etc.) from ten or more members of the public). Components may use this PTA
to assess internal, component-specific forms as well.
Form Number:

1670-0027

Form Title:

1670-New Emergency Response Operations Stakeholder
Feedback Form

Component:

Cybersecurity and
Infrastructure Security
Agency (CISA)

Office:

Integrated Operations
Division (IOD)
Emergency Response
Operations (ERO)
Branch

IF COVERED BY THE PAPERWORK REDUCTION ACT:
Collection Title:
Emergency Response Operations Stakeholder Feedback Form
OMB Control
Number:
Collection status:

Name:
Office:
Phone:

1670-0027
New Collection

OMB Expiration
Date:
Date of last PTA (if
applicable):

Click here to enter a
date.
Click here to enter
a date.

PROJECT OR PROGRAM MANAGER
John O’Connor
Branch Chief
Emergency Response
Title:
Operations
(703) 235-5028
Email:
[email protected]

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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

Name:
Office:
Phone:

COMPONENT INFORMATION COLLECTION/FORMS CONTACT
John Campbell
OCIO
Title:
Planning Administration
(PLAD), Section 508/PRA
(202) 689-5621
Email:
[email protected]
SPECIFIC IC/Forms PTA QUESTIONS

1. Purpose of the Information Collection or Form
a. Describe the purpose of the information collection or form. Please provide a
general description of the project and its purpose, including how it supports the DHS
mission, in a way a non-technical person could understand (you may use
information from the Supporting Statement).
If this is an updated PTA, please specifically describe what changes or upgrades are
triggering the update to this PTA.
CISA Central is CISA’s hub for staying on top of threats and emerging risks to our nation’s
critical infrastructure, whether they are of cyber, communications or physical origin. CISA
Central is the simplest, most centralized way for critical infrastructure partners and
stakeholders to engage with CISA and is the easiest way for all critical infrastructure
stakeholders to request assistance and get the information they need to understand the
constantly evolving risk landscape.
Through CISA Central, CISA coordinates situational awareness and response to national
cyber, communications, and physical incidents. CISA works closely with public, private
sector, and international partners, offering technical assistance, information security and
education to protect our nation’s critical infrastructure from a broad range of current cyber,
communication, and physical threats.
Within CISA Central, the Emergency Response Operations (ERO) Branch performs
emergency support functions to support CISA's roles as the Emergency Support Function
(ESF) Coordinator and Co-Primary Agency (along with FEMA) to support regional and
national disasters, supports Continuity and National Security Emergency Preparedness, and
serves as the Communications Information Sharing and Analysis Center (ISAC) for the
following:
• Emergency Support Function (ESF) #2 – Communications
• ESF #14 – Cross Sector Business and Infrastructure
Continuity and National Security Emergency Preparedness

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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

•

Plans, analyzes, conducts testing, and maintains responsibility for several operational
capabilities for the Federal Executive Branch.
National Coordinating Center for Telecommunications - Communications ISAC
• Organization by which the Federal Government and communications industry jointly
prepare for and maintain readiness to respond to emergency communications service
requirements.
CISA Central’s ERO interacts with a variety of stakeholders across multiple mission areas.
The purpose of the surveys is to capture stakeholder feedback on shared products to ensure
value to recipients and to guide and improve future products and processes. Collectively
potential survey respondents include Federal Departments and Agencies that support or need
disaster response situational awareness; State, Local, Territorial, and Tribal (SLTT) entities
supported by Federal response efforts; Federal partner entities with continuity communications
missions; International partners addressing infrastructure protection; communications industry
partners supporting resilient communications; critical infrastructure owner/operators; and
analyst consuming communications assessments.
The Emergency Response Operations (ERO) Branch Feedback Form consists of five customer
surveys:
• Emergency Response Operations Communications Analysis Survey Feedback Form.
• Emergency Support Function (ESF) #2 Survey Feedback Form.
• Emergency Support Function #14 Survey Feedback Form.
• ERO National Coordinating Center for Communications (NCC) - Information Sharing
and Analysis Center (ISAC) Survey Feedback Form.
• National Security Emergency Preparedness (NSEP) Continuity Survey Feedback
Form.
Analyzing feedback from stakeholders was recently identified as a recommendation in a
Government Accountability Office (GAO) Audit. A link will be provided to the various
distribution lists through Microsoft Forms.
As required under the Paperwork Reduction Act (PRA), this Privacy Threshold Analysis is
being completed because the survey forms, once approved by OMB, will collect feedback
from the public to assess the utility of CISA Central/ERO products in order to guide and
improve future products and processes. The feedback will include the collection of a limited
amount of personal identifiable information (PII) for the purposes of further communication
between SLTT respondents, industry private sector partners and CISA Central/ERO for any
necessary clarification of the feedback given.
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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

b. List the DHS (or component) authorities to collect, store, and use this information.
If this information will be stored and used by a specific DHS component, list the
component-specific authorities.
The creation of a feedback survey available to stakeholders is in response to a
recommendation recently identified in a Government Accountability Office (GAO) Report 22104462- GAO-22-104462 Critical Infrastructure Protection: CISA Should Assess the
Effectiveness of its Actions to Support the Communications Sector.
Therefore, CISA Central will collect, store, and use this information.

2. Describe the IC/Form
a. Does this form collect any
Personally Identifiable
Information” (PII1)?
b. From which type(s) of
individuals does this
form collect information?
(Check all that apply.)

c. Who will complete and
submit this form? (Check
all that apply.)

☒ Yes
☐ No
☒ Members of the public
☒ U.S. citizens or lawful permanent
residents
☒ Non-U.S. Persons.
☒ DHS Employees
☒ DHS Contractors
☒ Other federal employees or contractors.
☒ The record subject of the form (e.g., the
individual applicant).
☐ Legal Representative (preparer, attorney,
etc.).
☐ Business entity.
If a business entity, is the only
information collected business contact
information?
☐ Yes
☐ No
☐ Law enforcement.

1

Personally identifiable information means any information that permits the identity of an individual to be directly or indirectly inferred, including
any other information which is linked or linkable to that individual regardless of whether the individual is a U.S. citizen, lawful permanent resident,
visitor to the U.S., or employee or contractor to the Department.
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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

☐ DHS employee or contractor.
☐ Other individual/entity/organization that is
NOT the record subject. Please describe.
d. How do individuals
complete the form? Check
all that apply.

☐ Paper.
☐ Electronic. (ex: fillable PDF)
☒ Online web form. (available and submitted via
the internet)
Provide link:
https://forms.office.com/g/da1g6u6QDN
https://forms.office.com/g/3SykS8diuy
https://forms.office.com/g/hJ3HJ7k55J
https://forms.office.com/g/NAwpxqLR7x
https://forms.office.com/g/h2KzU0FmRL

e. What information will DHS collect on the form? List all PII data elements on the
form. If the form will collect information from more than one type of individual,
please break down list of data elements collected by type of individual.
The surveys are designed capture stakeholder feedback on shared products to ensure value to
recipients and to guide and improve future products and processes. In the survey, CISA
Central/ERO is asking internal and external partners for the usefulness and satisfaction of the
products that we send. This survey collection allows stakeholders to provide their email as
optional should further clarification be needed.
Email address is the only form of personally identifiable information to be collected on the
survey form.
f. Does this form collect Social Security number (SSN) or other element that is
stand-alone Sensitive Personally Identifiable Information (SPII)? Check all that
apply. Not Applicable
☐ Social Security number
☐ DHS Electronic Data Interchange
Personal Identifier (EDIPI)
☐ Alien Number (A-Number)
☐ Social Media Handle/ID
☐ Tax Identification Number
☐ Known Traveler Number
☐ Visa Number
☐ Passport Number
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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

☐ Bank Account, Credit Card, or other
financial account number
☐ Other. Please list:

☐ Trusted Traveler Number (Global
Entry, Pre-Check, etc.)
☐ Driver’s License Number
☐ Biometrics

g. List the specific authority to collect SSN or these other SPII elements.
Not Applicable
h. How will this information be used? What is the purpose of the collection?
Describe why this collection of SPII is the minimum amount of information
necessary to accomplish the purpose of the program.
The purpose of the surveys is to capture stakeholder feedback on shared products to ensure
value to recipients and to guide and improve future products and processes. This collection
does not contain SPII.

i.

Are individuals
provided notice at
the time of collection
by DHS (Does the
records subject have
notice of the
collection or is form
filled out by third
party)?

☒ Yes. Please describe how notice is provided.
Prior to the forms being approved by OMB and the PRA
Office, CISA Central/ERO will notify internal and external
partners of a voluntary survey attached to the different
products submitted. A Privacy Act statement will be at
the bottom of each form notifying each respondent of the
collection and use of information by CISA Central/ERO.
☐ No.

3. How will DHS store the IC/form responses?
a. How will DHS store
☐ Paper. Please describe.
the original,
Click here to enter text.
completed IC/forms?
☒ Electronic. Please describe the IT system that will
store the data from the form.
The survey will be stored online in CISA Microsoft's
cloud servers. CISA Central Standards and Evaluations
Team will have the sole authority to grant access to the
survey and its responses in individuals within CISA
Central/ERO who have an official need to know.
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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

☐ Scanned forms (completed forms are scanned into
an electronic repository). Please describe the
electronic repository.
Click here to enter text.
b. If electronic, how
does DHS input the
responses into the IT
system?

☐ Manually (data elements manually entered). Please
describe.
Click here to enter text.
☒ Automatically. Please describe.
The Stakeholder inputs their responses into
Microsoft Forms. Once the survey has been
completed, the responses remain in the forms
where they are reviewed by CISA Central/ERO

c. How would a user
search the
information
submitted on the
forms, i.e., how is the
information
retrieved?

☒ By a unique identifier.2 Please describe. If
information is retrieved by personal identifier, please
submit a Privacy Act Statement with this PTA.
Respondents email address
☒ By a non-personal identifier. Please describe.
Partner Type, title of report, and date of
report/product
The information collected by CISA/ERO will be retained in
accordance with the following schedule, DAA-GRS20170001-0001 Item 010 - Technical and Administrative
Help Desk Operational Records

d. What is the records
retention
schedule(s)? Include
the records schedule
number.
e. How do you ensure
that records are
disposed of or deleted
in accordance with
the retention
schedule?

In accordance with DAA-GRS-20170001-0001 Item 010,
records are to be destroyed 1 year after resolved, or when no
longer needed for business use, whichever is appropriate.

2

Generally, a unique identifier is considered any type of “personally identifiable information,” meaning any information that permits the identity
of an individual to be directly or indirectly inferred, including any other information which is linked or linkable to that individual regardless of
whether the individual is a U.S. citizen, lawful permanent resident, visitor to the U.S., or employee or contractor to the Department.
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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

f. Is any of this information shared outside of the original program/office? If yes,
describe where (other offices or DHS components or external entities) and why.
What are the authorities of the receiving party?
☐ Yes, information is shared with other DHS components or offices. Please describe.
Click here to enter text.
☐ Yes, information is shared external to DHS with other federal agencies, state/local
partners, international partners, or non-governmental entities. Please describe.
Click here to enter text.
☒ No. Information on this form is not shared outside of the collecting office.

Please include a copy of the referenced form and Privacy Act Statement (if
applicable) with this PTA upon submission.

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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

PRIVACY THRESHOLD REVIEW
(TO BE COMPLETED BY COMPONENT PRIVACY OFFICE)
Component Privacy Office Reviewer:

Cassio DaCunha

Date submitted to component Privacy
Office:
Date submitted to DHS Privacy Office:

March 11, 2022

Have you approved a Privacy Act
Statement for this form? (Only
applicable if you have received a
waiver from the DHS Chief Privacy
Officer to approve component Privacy
Act Statements.)

March 25, 2022
☐ Yes. Please include it with this PTA
submission.
☐ No. Please describe why not.
Click here to enter text.

Component Privacy Office Recommendation:
Please include recommendation below, including what existing privacy compliance
documentation is available or new privacy compliance documentation is needed.
CISA Central’s Emergency Response Operations (ERO) interacts with a variety of
stakeholders across multiple mission areas to support regional and national
disasters, supports Continuity and National Security Emergency Preparedness, and
serve as the Communications Information Sharing and Analysis Center. The purpose
of the feedback form is to capture stakeholder feedback on shared products to
ensure value to recipients and to guide and improve future products and processes.
The CISA Office of Privacy recommends that the use of the CISA Central ERO
Stakeholder Feedback Form is privacy sensitive due to its collection of personally
identifiable information and is covered by DHS/ALL/PIA – 006 DHS General Contacts
List and DHS/ALL/PIA-069 DHS Surveys, Interviews, and Focus Groups. The PII
collected is also covered under DHS/ALL – 002 Department of Homeland Security
(DHS) Mailing and Other Lists System November 25, 2008, 73 FR 71659.

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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

PRIVACY THRESHOLD ADJUDICATION
(TO BE COMPLETED BY THE DHS PRIVACY OFFICE)
DHS Privacy Office Reviewer:

Kattina Do

PCTS Workflow Number:
Date approved by DHS Privacy Office:
PTA Expiration Date

0022189
March 25, 2022
March 25, 2025

DESIGNATION
Privacy Sensitive IC or
Form:

Yes If “no” PTA adjudication is complete.

Determination:

☐ PTA sufficient at this time.
☐ Privacy compliance documentation determination in
progress.
☐ New information sharing arrangement is required.
☐ DHS Policy for Computer-Readable Extracts Containing SPII
applies.
☒ Privacy Act Statement required.
☒ Privacy Impact Assessment (PIA) required.
☒ System of Records Notice (SORN) required.
☐ Specialized training required.
☐ Other. Click here to enter text.

DHS IC/Forms Review:

DHS PRIV has approved this ICR/Form.

Date IC/Form Approved March 25, 2022
by PRIV:
IC/Form PCTS Number: Emergency Response Operations Stakeholder Feedback Form
Privacy Act
Choose an item.
Statement:
Click here to enter text.
PTA:
Choose an item.
Click here to enter text.
PIA:
System covered by existing PIA
If covered by existing PIA, please list:
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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

• DHS/ALL/PIA-069 DHS Surveys, Interviews, and Focus Groups
• DHS/ALL/PIA-006 General Contact Lists
If a PIA update is required, please list: Click here to enter text.
SORN:
System covered by existing SORN
If covered by existing SORN, please list:
• DHS/ALL-002 Department of Homeland Security (DHS) Mailing
and Other Lists System, November 25, 2008, 73 FR 71659
If a SORN update is required, please list: Click here to enter text.
DHS Privacy Office Comments:
Please describe rationale for privacy compliance determination above.
CISA is submitting this PTA to discuss the Emergency Response Operations
Stakeholder Feedback Form. CISA Central is CISA’s hub for staying on top of threats
and emerging risks to our nation’s critical infrastructure, whether they are of cyber,
communications or physical origin.
Within CISA Central, the Emergency Response Operations (ERO) Branch performs
emergency support functions to support CISA's roles as the Emergency Support
Function (ESF) Coordinator and Co-Primary Agency (along with FEMA) to support
regional and national disasters, supports Continuity and National Security
Emergency Preparedness, and serves as the Communications Information Sharing
and Analysis Center (ISAC).
CISA Central’s ERO interacts with a variety of stakeholders across multiple mission
areas. The purpose of the surveys is to capture stakeholder feedback on shared
products to ensure value to recipients and to guide and improve future products and
processes.
The Emergency Response Operations (ERO) Branch Feedback Form consists of five
customer surveys.
1. Emergency Response Operations Communications Analysis Survey Feedback
Form.
2. Emergency Support Function (ESF) #2 Survey Feedback Form.
3. Emergency Support Function #14 Survey Feedback Form.
4. ERO National Coordinating Center for Communications (NCC) - Information
Sharing and Analysis Center (ISAC) Survey Feedback Form.
5. National Security Emergency Preparedness (NSEP) Continuity Survey
Feedback Form.
Analyzing feedback from stakeholders was recently identified as a recommendation
in a Government Accountability Office (GAO) Audit. A link will be provided to the
various distribution lists through Microsoft Forms.
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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

The surveys are designed capture stakeholder feedback on shared products to
ensure value to recipients and to guide and improve future products and processes.
In the survey, CISA Central/ERO is asking internal and external partners for the
usefulness and satisfaction of the products that we send. This survey collection
allows stakeholders to provide their email as optional should further clarification be
needed. Email address is the only form of personally identifiable information to be
collected on the survey form.
The DHS Privacy Office (PRIV) agrees that this form is privacy-sensitive, requiring
PIA and SORN coverage because PII is collected from members of the public, DHS
personnel, and other federal employees.
PRIV agrees with CISA Privacy that PIA coverage is provided by DHS/ALL/PIA-069
DHS Surveys, Interviews, and Focus Groups provides transparency into the privacy
risks associated with DHS’s collection, maintenance, and use of PII in order to
facilitate correspondence via a survey. Additionally, PIA coverage is provided by
DHS/ALL/PIA-006 DHS General Contact Lists, which covers the collection of contact
information to conduct agency operations.
SORN coverage is required because information is retrieved by personal identifier.
PRIV agrees with CISA Privacy that SORN coverage is provided by DHS/ALL-002
Department of Homeland Security (DHS) Mailing and Other Lists System, which
covers the lists used to facilitate mailings to multiple addressees and other activities
in furtherance of DHS duties.
CISA is required to update and use the Privacy Act Statement attached to this PTA.
Also, any updates to this form will require an update to this PTA.

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