OMB control number

US Department of Justice Self Reportable Activities

OMB 1103-0119 · DOJ/DOJADM.

OMB 1103-0119

Self-reporting requirements per Policy Statement 1700.04 Department Personnel Security Reporting Requirements apply to non-federal employee personnel affiliated with DOJ. The policy contains reporting requirements applicable to entire workforce while additional reporting requirements apply to personnel occupying national security positions or having access to classified information. This request is to receive approval or reporting process (system and forms) for non-federal population.

The latest form for US Department of Justice Self Reportable Activities expires 2027-04-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 1103-NEW DOJ Self Reportable Activities Form and Instruction
Form 1103-NEW US Department of Justice Self Reportable Activities Form and Instruction
ODAG Approval for OMB #1103-0119.pdf Supplementary Document
ODAG Approval for OMB #1103-0119.pdf Supplementary Document
1103-NEW US Department of Justice Self Reportable Activities 30 Day Notice.htm Supplementary Document
1103-NEW US Department of Justice Self Reportable Activities 30 Day Notice.htm Supplementary Document
1103-0119 Supporting Statement Part A 2022.docx Supporting Statement A
1103-0119 Supporting Statement Part A 2022.docx Supporting Statement A
US Department of Justice Self Reportable Activities Form and Instruction
US Department of Justice Self Reportable Activities Form and Instruction

All Historical Document Collections

202507-1103-001	Reinstatement without change of a previously approved collection	2025-07-07
202203-1103-001 Approved without change	Extension without change of a currently approved collection	2022-03-18
201808-1103-001 Approved without change	New collection (Request for a new OMB Control Number)	2018-10-29