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 can be found here.

Latest Forms, Documents, and Supporting Material
Document
Name
Not Impacted Letter.docx (document unavailable)
Supplementary Document
Impacted-BI no prints Letter.docx (document unavailable)
Supplementary Document
Impacted-BI prints Letter.docx (document unavailable)
Supplementary Document
Impacted-BI no prints Letter.docx (document unavailable)
Supplementary Document
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 (document unavailable)
Supplementary Document
Supporting Statement A