Required Protected Critical Infrastructure Information (PCII) Regulation Statements

This page provides information for required statements that must be included with all Protected Critical Infrastructure Information (PCII) protection requests. All information submitted for PCII protection must include:

  • An Express Statement requesting the protection offered by the Critical Infrastructure Information (CII) Act
  • A Certification Statement including the submitter’s contact information and certifying that the information is not customarily in the public domain

Express Statement

The Express Statement must be included with all information submitted for PCII protection.

Please copy and paste the following information for your Express Statement:

This information is voluntarily submitted to the federal government in expectation of protection from disclosure as provided by the provisions of the Critical Infrastructure Information Act of 2002.

Certification Statement

The Certification Statement must be included with all information submitted for PCII protection.

Please copy and paste the following information for your Certification Statement. This must be completed, signed, and dated:

To the best of my knowledge, information, and belief, the information being submitted is not customarily in the public domain. 

I attest that I am not submitting this information in lieu of complying with a regulatory requirement. 

I am authorized to submit this information to be considered for protection under the Critical Infrastructure Information Act of 2002.

[Affix your signature and date signed.]

Submitter Name:
Submitter Title:
Organization or Company Name (if applicable):
Mailing Address:
City:
Office Telephone:
Alternate Telephone:
Email Address:

Alternate Contact Name:
Alternate Contact Title:
Organization or Company Name (if different from submitter):
Mailing Address:
City:
State:
Office Telephone:
Alternate Telephone:
Email Address:

Please be aware that any knowing or willful false representations provided in this submission may constitute a violation of 18 U.S.C. 1001 and are punishable by fine and imprisonment.

Related Resources

Contact Information

To learn more about how the PCII Program can support your organization's homeland security efforts, please contact PCII-Assist@hq.dhs.gov.

Last Published Date: August 22, 2018

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