Privacy Assessment

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NAME OF INFORMATION COLLECTION REQUEST: FBI Expungment and Scaling Form
0MB CONTROL NUMBER (IF APPLICABLE): 0MB 1110-0064
COMPONENT: Biometric Services Section, Criminal History Information and Policy Unit
PROGRAM MANAGER (OR PROGRAM MANAGER
DELEGATE)
Name: Brian A. Cain
Office: Criminal History Information and Policy Unit
Phone: 771-228-8721
Bldg./Room Number: BTC3
Email: [email protected]

COMPONENT PRA COORDINATOR
Name: Kirtlin W. Doyle
Office: Internal Policy Office
Phone: 202-324-3520
Bldg./Room Number: JEH/9798
Email: [email protected]
SENIOR COMPONENT OFFICIAL FOR PRIVACY
(where applicable) OR COMPONENT PRIVACY
POINT OF CONTACT
Name: Roxane Panarella
Office: Privacy and Civil Liberties Unit
Phone: 3046254055
Bldg./Room Number: BTC3
Email [email protected]

ICR-PA Certification & Signature

On behalf of my component, I certify that:

(I) I have reviewed all collection instruments associated with this !CR:
(2) I have completed the !CR-PA below for the collection instrument(s) associated with this !CR;
(3) I have coordinated closely with the component PRA Coordinator and SCOP (or other appropriate component
privacy representative) in assessing and answering each of the !CR-PA questions below;
(4) To the extent the collection instrument(s) associated with this !CR require(s) a privacy-related notice(s), I have
coordinated internally to ensure that the appropriate notice(s) has/have been drafted; that the notice(s) is/are
conspicuous, salient, clearly labeled, and written in plain language; and that the notice(s) is/are appropriately
displayed as required by law or policy; and
(5) I will reassess the information in this ICR-PA, in accordance with the Department's !CR process, should the
instrument(s) associated with this !CR materially change.
Pmg.-am Maaager Name:
Pmgram Maoager Sig"•'"'°'
Date signed:

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08/29/2025

Please prepare the ICR-PA per the guidance provided in the questions on the template
below. If the ICR contains multiple collection instruments an assessment should be
completed for each instrument

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ICR
a
Instrument N me:

FD-1222 Restoration of Federal Firearm Rights

0MB Control Number (if applicable):

_____________
_
OMB 1110-0046

I . Which of the following describes the collection.

D Electronic only.
D Paper only.

[X]Combination paper/
electronic.
2. Does the ICR include a collection instrument (either physical or electronic)?

[X] Yes.

D No.

[If you marked .. Yes, .. proceed to question 3].

[If you marked ··No;· STOP here. Additional privacy statements are not
necessary for this collection].
3. Please indicate if any of the following characteristics apply to the information collected:
(Check all that apply.)

[X] The information directly identifies specific individuals.

[ ] The information is intended to be used, in conjunction with other data elements, to
indirectly identify specific individuals.
[ ] The information can be used to distinguis_h or trace an individual's identity (i.e., it is
linked or linkable to specific individuals).
[If you marked any of the above, proceed to question 4.]

D None of the above.

[If you checked ·'None of the above,"' STOP here. Additional privacy statements are not
necessary for this collection].

4. ls the component requesting an individual to disclose his/her Social Security Number (SSN)?

[ ] No.

[If you marked ··No;· proceed to question 5].

[X] Yes. [A SSN Statement may be required, pursuant to the Privacy Act.
Coordinate
with your SCOP to draft an appropriate statement. Proceed to the next questions to
determine whether additional notifications are required].

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5. Is the component collecting the information using an online interface (e.g., a webpage)?

[X] No. [If you marked .. No;· proceed to question 6].

[ ]Yes. [A privacy notice may be required. pursuant to 0MB M-17-06.
Coordinate
with your SCOP to draft an appropriate statement. Proceed to the next questions to
determine whether additional notifications are required].

6. Will information about United States citizens or lawfully admitted permanent resident aliens be
retrieved from the instrument by a personal identifier (e.g., by name)?

D No. [lf you marked --No:· STOP here. Additional privacy statements are not

necessary for this collection, but you mav have additional privacv-related
requirements beyond those discussed in this ICR-PA. Consult vour SCOP to
identify additional privacy-related requirements, if any.l

[Z] Yes, [If you marked .. Yes:· proceed to question 7].
7. Is there an existing Privacy Act System of Records Notice (SORN) that has been published in
the Federal Register that will sufficiently cover this new collection? (Please consult with your
component's SCOP, Privacy Act officer, General Counsel, or OPCL if assistance is needed in
responding to this question.)

D No. [If you marked "No," contact your SCOP/OPCL. An accurate SORN must

be published before a component may collect this information].

[Z] Yes. [If you marked --Yes,·· proceed to question 8].
8. Does the existing SORN properly reflect this new information to be collected? (Please consult
with your component's SCOP, Privacy Act officer, General Counsel, or OPCL if assistance is
needed in responding to this question.)

[]

No. [If you marked "No," contact your SCOP/OPCL. An accurate SORN
be
must published before a component may collect this information].

[X] Yes. [A Privacy Act Statement may be required, pursuant to the Privacy
Act. Coordinate with your SCOP to draft an appropriate statement].

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