Application for Transfer of SAFETY Act Designtation

Support Anti-terrorism by Fostering Effective Technologies Act of 2002

Documents and Forms

Document Name Document Type
Form DHS Form 10001 Application for Transfer of SAFETY Act Designtation Form and Instruction
DHS Form 10001 Application for Trnsfer of SAFETY Act Designation 10001_Application_for_Transfer_of_SAFETY_Act_Designation.pdf Form and Instruction
DHS Form 10001 Application for Trnsfer of SAFETY Act Designation 10001_Application_for_Transfer_of_SAFETY_Act_Designation.pdf Form and Instruction
DHS Form 10005 SAFETY ACT BLOCK DESIGNATION APPLICATION 10005_SAFETY_Act_Block_Designation.docx www.safetyact.gov Form and Instruction
DHS Form 10005 SAFETY ACT BLOCK DESIGNATION APPLICATION 10005_SAFETY_Act_Block_Designation.docx www.safetyact.gov Form and Instruction

Information Collection (IC) Details

IC Title:	Application for Transfer of SAFETY Act Designtation	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DHS Form 10001	Application for Trnsfer of SAFETY Act Designation	10001_Application_for_Transfer_of_SAFETY_Act_Designation.pdf		Yes	No	Fillable Fileable
Form and Instruction	DHS Form 10005	SAFETY ACT BLOCK DESIGNATION APPLICATION	10005_SAFETY_Act_Block_Designation.docx	http://www.safetyact.gov	Yes	Yes	Fillable Fileable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	20	10	10
Annual IC Time Burden (Hours)	200	120	80
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.