USDA PIV Request for Credential

OMB 0505-0022

This form collects information related to USDA employees, contractors, and non-employee affiliates applying for a USDA credential (identification card), in accordance with Homeland Security Presidential Directive 12 and Federal Information Processing Standard 201.

The latest form for USDA PIV Request for Credential expires 2023-05-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form AD-1197 USDA PIV Request for Credential Form
0505-0022 SuptStmt.docx Supporting Statement A
HSPD-12 Directive_001.pdf Supplementary Document
USDA PIV Request for Credential Form

All Historical Document Collections

202305-0505-001 Approved with change	Revision of a currently approved collection	2023-05-31
202004-0505-001 Approved without change	Revision of a currently approved collection	2020-04-17
201702-0505-001 Approved without change	Extension without change of a currently approved collection	2017-02-13
201308-0505-001 Approved without change	Revision of a currently approved collection	2013-08-19
200906-0505-001 Approved without change	Revision of a currently approved collection	2009-06-30
200604-0505-001 Approved without change	Revision of a currently approved collection	2006-04-27
200510-0505-001 Approved without change	New collection (Request for a new OMB Control Number)	2005-10-20