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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.
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