Personnel Security Clearance Change Notification

ICR 201101-0704-003

OMB: 0704-0418

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2011-01-31
IC Document Collections
IC ID
Document
Title
Status
5509 Modified
ICR Details
0704-0418 201101-0704-003
Historical Active 200712-0704-005
DOD/DODDEP
Personnel Security Clearance Change Notification
Extension without change of a currently approved collection   No
Regular
Approved without change 04/05/2011
Retrieve Notice of Action (NOA) 01/31/2011
This collection is cleared for one year. DOD must submit in one year with a revised privacy act statement on this form.
  Inventory as of this Action Requested Previously Approved
04/30/2012 36 Months From Approved 04/30/2011
225,800 0 225,800
45,160 0 45,160
0 0 0

The DISCO Form 562 is used by contractors participating in the National Industrial Security Program to report various changes in employee personnel clearance status or identification information, e.g., reinstatements, conversions, terminations, changes in name or other previously submitted information. These requirements are necessary in order to preserve and maintain the security of the United States through establishing standards to prevent the improper disclosure of classified information.

EO: EO 10865 Name/Subject of EO: null
   EO: EO 12829 Name/Subject of EO: null
  
None

Not associated with rulemaking

  72 FR 48988 08/27/2007
72 FR 72679 12/21/2007
No

1
IC Title Form No. Form Name
Personnel Security Clearance Change Notification DISCO Form 562 Personnel Security Clearance Change Notification

  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 225,800 225,800 0 0 0 0
Annual Time Burden (Hours) 45,160 45,160 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$227,604
No
No
No
No
No
Uncollected
Patricia Toppings 703 696-5284 PLToppings@whs.mil

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
01/31/2011


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