Information Collection

State, Local, Tribal and Private Sector Clearance Request Form

IC 214622 under ICR 202610-1670-001 · OMB 1670-0013.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DHS 9014 PRIVATE SECTOR CLEARANCE PROGRAM REQUEST State, Local, Tribal and Private Sector Clearance Request Form	Form and Instruction
DHS 9014 PRIVATE SECTOR CLEARANCE PROGRAM REQUEST DHS Form 9014.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	DHS 9014				Yes	Yes	Fillable Fileable Signable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records

Title: Department of Homeland Security/ALL--023 Personnel Security Management System of Records

FR Citation: 75 FR 8088

Number of Respondents: 550

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	550	550
Annual IC Time Burden (Hours)	92	92
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.

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