OMB control number
Collection of Required Data Elements to Verify Eligibility
OMB 0704-0545 · DOD/DODDEP.
OMB 0704-0545
This is a request for extension for a collection of information necessitated by the Office of Personnel Management (OPM) cybersecurity incident in which approximately 21.5 million security clearance background investigation records containing personally identifying information (PII) were compromised. The information collected will be used only to verify whether or not an individual was impacted by the OPM cybersecurity incident involving background investigation records and to send a letter confirming status as “impacted” or “not impacted” by this incident.
The latest form for Collection of Required Data Elements to Verify Eligibility expires 2029-04-30 and is listed under ICR 202601-0704-006.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Not Impacted Letter.docx (document unavailable) | Supplementary Document |
| Impacted-BI no prints Letter.docx | Supplementary Document |
| Impacted-BI prints Letter.docx | Supplementary Document |
| Impacted-BI no prints Letter.docx | Supplementary Document |
| Impacted-PR BI prints Letter.docx | Supplementary Document |
| Impacted-PR Only Letter.docx (document unavailable) | Supplementary Document |
 OATSDPCLT_PSBNMR_SSNJ Decision Memo_Signed.pdf (document unavailable) | Supplementary Document |
| PIA_DMDC_20_OPM-V_Sec1.pdf | Supplementary Document |
| 0704-0545_SSA_2.26.26.docx | Supporting Statement A |
 Collection of Required Data Elements to Verify Eligibility |
Other-Screenshots |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202601-0704-006 | Extension without change of a currently approved collection | 2026-02-26 | Approved without change | |
| 202205-0704-002 | Revision of a currently approved collection | 2022-09-29 | Approved without change | |
| 201907-0704-005 | Revision of a currently approved collection | 2019-07-31 | Approved without change | |
| 201606-0704-001 | Revision of a currently approved collection | 2016-06-01 | Approved without change | |
| 201512-0704-004 | No material or nonsubstantive change to a currently approved collection | 2015-12-11 | Approved with change | |
| 201510-0704-002 | New collection (Request for a new OMB Control Number) | 2015-10-14 | Approved without change |