Narrative of Changes to Forms

SAFETY Act Form Changes
Changes to All Forms:
1. Inserted OMB Form Number and Expiration Date in Header of documents as well as PRA
Burden Statement to include DHS Form Number in Footer.
2. Formatting changed to include 1” margins on all sides and consistent fonts and text sizes.
a. This included ensuring all cover pages of forms had similar format.
DHS Form 10001: Application for Transfer of SAFETY Act Designation
1. Question T1.2 added
2. T3.1 and T3.3 added
3. T6: Listed type of insurance information required for this question
4. T7 added
5. Instructions updated to reflect changes.
DHS Form 10002: Notice of Modification
1. Expanded M3 to break out between M3.1 “Technical Modification” and M3.2 “Insurance
Petition”
2. Instructions updated to reflect changes.
DHS Form 10003: Notice of License
1. No changes (other than formatting listed above)
DHS Form 10004: SAFETY Act Block Certification
1. No changes (other than formatting listed above)
DHS Form 10005: SAFETY Act Block Designation
1. No changes (other than formatting listed above)
DHS Form 10006: Application for Developmental Testing and Evaluation Designation
1. TE5 Question reworded.
2. Instructions updated to reflect changes.
DHS Form 10006: Application
for Developmental Testing and
Evaluation Designation
TE5 Question reworded.

Previous CI

New CI

Description Specification of your
Technology. Describe your
Technology in detail. This
description will serve as the basis
for the Department's analysis of
your Technology for SAFETY Act
Purposes. The content of the
response you provide in this
section, together with any
additional information you may
be asked to provide, may be
used to finalize of the definition
and scope of your Technology as
it will appear in a Developmental
Testing and Evaluation
Designation.

Description of your Technology.
One of the most important parts
of the application process is
defining the scope of your
Technology. In this section,
define your Technology with a
sufficient degree of specificity.
This description will serve as the
basis for the Department’s
analysis of your Technology for
SAFETY Act purposes. The
content of the response you
provide in this section, together
with any additional information
you may be asked to provide,
may be used to finalize the
definition and scope of your

Technology as it will appear in a
Developmental Testing and
Evaluation Designation.
DHS Form 10007: Application for SAFETY Act Certification
1. No changes (other than formatting listed above)
DHS Form 10008: Application for SAFETY Act Designation
1. D5 reworded.
2. D8 condensed to remove repetitive instructions.
3. D9 reworded.
4. More detail to D10 added.
5. More detail to D11 added.
6. More detail to D14 added.
7. Instructions updated to reflect changes.
DHS Form 10008: Application
for SAFETY Act Designation
D5 reworded.

D8 condensed to remove
repetitive instructions.

Previous CI

New CI

Nature of your Technology. If
your Technology is a product or
device, please describe the
Technology in detail, including its
principal elements, system and
components. If your Technology
is a service, please describe the
nature of the service, the
actions, activities, planning,
training, and/or expertise
involved in providing the service
and how the service is designed
to counter terrorist threats. If
your Technology is an
"integrator" of various products,
services, or legacy systems
indicate how the Technology will
integrate the various component
parts.

Summary of your Technology.
Please provide a brief (no more
than two-page) overall
description of your Technology.
If your Technology is a product
or device, please describe the
Technology, including its
principal elements, subsystems
and components. If your
Technology is a service, please
provide an overview of the
nature of the service, the
actions, activities, planning,
training, and/or expertise
involved in providing the service
and how the service is designed
to counter terrorist threats. If
your Technology is an
“integrator” of various products,
services, or legacy systems,
indicate how the Technology will
integrate the various component
parts.
Provide the earliest date of sale
of the Technology for which you
are requesting SAFETY Act
coverage. This should represent
the date that the Technology
was first deployed, used or
modified to be used in an Antiterrorism context. Please

Provide the earliest date of sale
of the Technology for which you
are requesting SAFETY Act
coverage.

D9 reworded.

Description of your Technology.
Describe your Technology in
detail. This description will serve
as the basis for the Department's
analysis of your Technology for
SAFETY Act purposes. The
content of the response you
provide in the section, together
with any additional information
you may be asked to provide,
may be used to finalize of the
definition and scope of your
Technology as it will appear in a
Designation.

More detail to D10 added.

Deployment and Operation.
Describe the sequence of steps
involved in deploying and
operating your Technology.

More detail to D11 added.

Readiness for Sale. How ready is
your Technology to be sold and
deployed?

More detail to D14 added.

Effectiveness and Utility. Provide
information supporting the
potential for your Technology to

provide a justification of the date
used.
Description of your Technology.
One of the most important parts
of the application process is
defining the scope of your
Technology. In this section,
define your Technology with a
sufficient degree of specificity.
This description will serve as the
basis for the Department’s
analysis of your Technology for
SAFETY Act purposes. The
content of the response you
provide in this section, together
with any additional information
you may be asked to provide,
may be used to finalize the
definition and scope of your
Technology as it will appear in a
Designation. Refer to the
instructions for a more detailed
example.
Deployment and Operation.
Describe the sequence of steps
involved in deploying and
operating your Technology.
Provide sufficient detail to show
that your company is capable of
supplying your Technology. Be
specific about all activities such
as the development,
implementation, operation and
management, etc. required to
deploy your Technology.
Readiness for Sale. How ready is
your Technology to be sold and
deployed? Please describe any
modifications, adjustments,
start-up time, hiring and vetting
of personnel, building of
manufacturing facilities, or other
processes which might be
required prior to a new
deployment.
Effectiveness and Utility.
Provide information supporting
the potential for your

be effective in countering
potential acts of terrorism.
Please provide internal or
external effectiveness tests or
other information indicating the
effectiveness of your
Technology. This can include
acceptance test data from a
government contracting action,
customer feedback or other
relevant data or experience. As
noted, acceptance of your
Technology by a government
purchaser may be highly relevant
and expedite approval or your
application.

Technology to be effective in
countering potential acts of
terrorism. Please provide
internal or external effectiveness
tests or other information
indicating the effectiveness of
your Technology. This can
include acceptance test data
from a Government contracting
action, penetration tests, case
studies, pre and post-training
testing, incident reports,
customer feedback, or other
relevant data or experience. As
noted, acceptance of your
Technology by a Government
purchaser may be highly relevant
and expedite approval of your
application.
It is important that effectiveness
data be in documented form if at
all possible. You are responsible
for providing all documentation
in support of your application at
the time of submittal, or to
facilitate the transfer of any such
information prior to submission.
In the event that obtaining
documentation is not possible
and if POCs are provided as
sources of information or
testimonials, check below to
indicate that you have contacted
them and that they are
expecting to hear from DHS
related to your Technology.
Also, indicate below specifically
what information we should
expect from each POC. Please
see the Instructions for
additional information.

DHS Form 10009: Application for a Pre-Application Consultation
1. No changes (other than formatting listed above)
DHS Form 10010: Registration as a Seller

1. No changes (other than formatting listed above)
DHS Form 10057: Application for Renewal
1. This is a new form, so all content is original. (Form will be used when Anti-Terrorism
technologies (ATT) are set to expire and require renewal in order to remain approval of
SAFETY Act Designation or Certification).