OMB control number
Contractor Fitness/Security Screening Request Form
OMB 1601-0039 ยท DHS/OS.
OMB 1601-0039
This collection of information is necessary to initiate the contractor fitness screening process for determining whether a person (i.e., the respondent) who has been invited to perform work under a contract for, or on behalf of the Department of Homeland Security (DHS), should be deemed fit to perform such work and eligible for logical and/or physical access to DHS resources based on the risk levels of the designated position. The respondent is responsible for providing and/or verifying information to complete Section II of DHS Form 11000-25; the remaining sections of DHS Form 11000-25 (Sections I, III, and IV) are completed by DHS federal employees
The latest form for Contractor Fitness/Security Screening Request Form expires 2027-04-30 and is listed under ICR 202311-1601-001.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 privacy_pia_dhswide_isms-2011.pdf | Supplementary Document |
| 1600-0004 Contractor Fitness Security Screening SORN 85 FR 64511 11-12-2020.pdf | Supplementary Document |
| 30 Day FRN 88 FR 73038 10-24-2023.pdf | Supplementary Document |
| 60-Day FRN 88 FR 55469 8-15-2023.pdf | Supplementary Document |
| Homeland Security Presidential Directive 12.pdf | Supplementary Document |
| FAR 52.204-9.pdf | Supplementary Document |
| FAR 52.204-2.pdf | Supplementary Document |
| Executive Order 13764.pdf | Supplementary Document |
| Executive Order 13467.pdf | Supplementary Document |
| Executive Order 10577.pdf | Supplementary Document |
| Executive Order 9397.pdf | Supplementary Document |
| 5 CFR Part 732.pdf | Supplementary Document |
| 5 CFR Part 731.pdf | Supplementary Document |
 1601-NEW Contractor Fitness Security Screening Request Form SS_A (DHS Form 11000-25).docx | Supporting Statement A |
 Contractor Fitness/Security Screening Request Form DHS Form 11000-25 |
Information collection |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202311-1601-001 | New collection (Request for a new OMB Control Number) | 2023-11-15 | Approved without change |