83i

PAPERWORK REDUCTION ACT SUBMISSION
Please read the instructions before completing this form. For additional forms or assistance in completing this form contact your agency's Paperwork Clearance Officer. Send
two copies of this form, the collection instrument to be reviewed, the Supporting Statement, and any additional documentation to: Office of Information and Regulatory
Affairs, Office of Management and Budget, Docket Library, Room 10102, 72 17th Street NW, Washington, DC 20503.
1. Agency/Subagency originating request

Department of Justice, Federal Bureau of Investigation ,
Criminal Justice Information Services Division
3. Type of information collection (check one)
a.
New collection
b. T Revision of a currently approved collection
c. __ Extension of a currently approved collection
d.
Reinstatement, without change, of a previously approved
collection for which approval has expired
e.
Reinstatement, with change, of a previously approved
collection for which approval has expired
f.
Existing collection in use without an OMB control number
For b-f, note Item A2 of Supporting Statement Instructions

2. OMB control number
a. 1 1 1 0 - 0 0 3 9

b. Q None

4. Type of review requested (check one)
a. T Regular
b.
Emergency - Approval requested by: ___/___/___
c.
Delegated
5. Small entities
Will this information collection have significant economic impact
on a substantial number of small entities?
Yes T No
6. Requested expiration date
a. T Three years from the approval date
b.
Other Specify: ____/____

7. Title: Federal Bureau of Investigation Bioterrorism Preparedness Act: Entity/Individual Information
8. Agency form number(s) (if applicable) FD-961
9. Keywords Bioterrorism, Select Agents, Toxins, Security Risk Assessment
10. Abstract Utilize the FD-961 form to complete security risk assessments on individuals and make recommendations as to whether individuals

should be denied access or granted limited access to specific agents.
11. Affected public (M ark prim ary with "P" and all others that apply with "X")
a. x Individuals or households
d.
Farms
b. x Business or other for profit e. x Federal Government
c. x Not-for-profit institutions
f. P State, Local, or Tribal Government

12. Obligation to respond (M ark prim ary with "P" and all others that apply with "X")
a.
Voluntary
b.
Required to obtain or retain benefits
c. P Mandatory

13. Annual reporting and record keeping hour burden
a. Number of respondents
b. Total annual responses
1. Percentage of these responses
collected electronically
c. Total annual hours requested
d. Current OMB Inventory
e. Difference
f. Explanation of difference
1. Program Change
2. Adjustment

14. Annual reporting and record keeping cost burden (in thousands of dollars)
a. Total annualized capital/startup costs
0
b. Total annual costs (O&M)
0
c. Total annualized cost requested
724
d. Current OMB Inventory
865
e. Difference
-141
f. Explanation of difference
1. Program Change
2. Adjustment
-141

4,005 (FY11)
4,005 (FY11)
0%
3,004
3588
-584

-584

15. Purpose of information collection (Mark primary with "P" and all others
that apply with "X")
a.
Application for benefits
e.
Program planning or management
b.
Program Evaluation
f.
Research
c.
General Purpose Statistics
g. P Regulatory or Compliance
d.
Audit

16. Frequency of recordkeeping or reporting (check all that apply)
a.
Recordkeeping
b.
Third Party Disclosure
c. T Reporting
1. 9 On occasion 2. x Weekly
3. 9 Monthly
4. 9 Quarterly
5. 9 Semi-annually 6. 9 Annually
7. 9 Biennially
8. 9 Other (describe) ____________

17. Statistical Methods
Does this Information Collection employ statistical methods?

18. Agency contact (person who can best answer questions regarding the content of
this submission)

9 Yes

: No

Name: John E. Strovers, Supervisory Personnel Security

Phone:

OM B 83-I

Specialist
NICS Strategy and Systems Unit
FBI, CJIS Division
(304) 625-4766
10/95