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Privacy Act Statement
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OMB Control Number: 1670-0028
Expiration Date: 02/29/2020
Authority: NPPD is authorized to collect the information requested pursuant to 5 U.S.C. § 301, 44 U.S.C. § 3101, 44 U.S.C. § 3554, 6 U.S.C. § 111, Presidential Policy Directive 17, and Homeland Security Presidential Directive 19.
Purpose: NPPD is requesting this information to grant user access to the Technical Resource for Incident Prevention (TRIPwire) Portal and, if elected by the user, to disclose the user’s contact information via the TRIPwire Member Directory.
Routine Uses: The information requested on this form may be shared externally as a “routine use” to other government agencies to assist the Department of Homeland Security. A complete list of the routine uses can be found in the system of records notices associated with this form, DHS/ALL-004 - General Information Technology Access Account Records System (GITAARS) and DHS/ALL-002 - Department of Homeland Security (DHS) Mailing and Other Lists System of Records. The Department’s full list of system of records notices can be found on the Department's website at
Disclosure: Providing this information to is voluntary. However, failure to provide the information requested may prevent user access being granted and prevent information from being displayed in the member directory.
Paperwork Burden Notice: The public reporting burden for this form is estimated to be 10 minutes. The burden estimate includes time for reviewing instructions, researching existing data sources, gathering and maintaining the needed data, and completing and submitting the form. Your response is voluntary. You are not required to respond to this collection of information unless a valid OMB control number is displayed. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden to Department of Homeland Security, IP/PSCD, Mail Stop 8540, 245 Murray Lane SW, Washington, DC 20528-8540. ATTN: PRA (1670-XXXX). NOTE: DO NOT send your completed form to this address.
WARNING: You are about to access a Department of Homeland Security computer system. This computer system and data therein are property of the U.S. Government and provided for official U.S. Government information and use. There is no expectation of privacy when you use this computer system. The use of a password or any other security measure does not establish an expectation of privacy. By using this system, you consent to the terms set forth in this notice. You may not process classified national security information on this computer system. Access to this system is restricted to authorized users only. Unauthorized access, use, or modification of this system or of data contained herein, or in transit to/from this system, may constitute a violation of section 1030 of title 18 of the U.S. Code and other criminal laws. Anyone who accesses a Federal computer system without authorization or exceeds access authority, or obtains, alters, damages, destroys, or discloses information, or prevents authorized use of information on the computer system, may be subject to penalties, fines or imprisonment. This computer system and any related equipment is subject to monitoring for administrative oversight, law enforcement, criminal investigative purposes, inquiries into alleged wrongdoing or misuse, and to ensure proper performance of applicable security features and procedures. DHS may conduct monitoring activities without further notice. Use of this system constitutes consent to monitoring for these purposes and implies understanding of these terms and conditions.
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