Department of Defense Security Agreement

Forms and Documents

Document Name	Status
Form DD Form 441 Department of Defense Security Agreement Form	Modified
Form DD Form 441-1 APPENDAGE TO DEPARTMENT OF DEFENSE SECURITY AGREEMENT Form	New
0704-0194_SSA_9.25.2019.doc Supporting Statement A	2019-09-25

IC Document Collections

IC ID	Document Title	Status
5289	Department of Defense Security Agreement Form	Modified
237805	APPENDAGE TO DEPARTMENT OF DEFENSE SECURITY AGREEMENT Form	New

ICR Details

OMB Control No: 0704-0194	ICR Reference No: 201909-0704-003
Status: Active	Previous ICR Reference No: 201607-0704-003
Agency/Subagency: DOD/DODDEP	Agency Tracking No:
Title: Department of Defense Security Agreement
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/29/2019
	Date Received in OIRA: 09/25/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2022	36 Months From Approved	10/31/2019
Responses	4,021	0	6,851
Time Burden (Hours)	870	0	4,171
Cost Burden (Dollars)	38,090	0	182,702

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Abstract: The execution of the DD Forms 441 and 441-1 are factors in making a determination as to whether a contractor is eligible to have a facility security clearance. They are also a legal basis for imposing National Security Program (NISP) security requirements on eligible contractors.

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Authorizing Statute(s): EO: EO 12829 Name/Subject of EO: National Industrial Security Program
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 35858	07/25/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 50429	09/25/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Department of Defense Security Agreement	DD Form 441	DEPARTMENT OF DEFENSE SECURITY AGREEMENT
APPENDAGE TO DEPARTMENT OF DEFENSE SECURITY AGREEMENT	DD Form 441-1	APPENDAGE TO DEPARTMENT OF DEFENSE SECURITY AGREEMENT

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	4,021	6,851	0	-2,830	0	0
Annual Time Burden (Hours)	870	4,171	0	-3,301	0	0
Annual Cost Burden (Dollars)	38,090	182,702	0	-144,612	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Changing Forms

Short Statement: SF 328 was removed from this collection and cleared separately so that it could be used as a common form.

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Annual Cost to Federal Government: $133,731

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/25/2019

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