Information Collection

White House Communications Agency Security Screening Questionnaire

IC 209218 under ICR 202407-0704-005 · OMB 0704-0507.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form WHCA Form 89 White House Communications Agency Security Screening Questionnaire	Form and Instruction
WHCA Form 89 WHITE HOUSE COMMUNICATIONS AGENCY SECURITY SCREENING QUE SSQ Fillable - WHCA Form 89.pdf	Form and Instruction
WHCA Form 89 WHITE HOUSE COMMUNICATIONS AGENCY SECURITY SCREENING QUE SSQ Fillable - WHCA Form 89.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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	WHCA Form 89	WHITE HOUSE COMMUNICATIONS AGENCY SECURITY SCREENING QUESTIONNAIRE (SSQ)	SSQ Fillable - WHCA Form 89.pdf		Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

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	Previously Approved
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	38	38
Annual IC Cost Burden (Dollars)	1,437	1,437

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.