The Texas Department of Public Safety form is a crucial document used for regulatory purposes within the Private Security sector. This form must be completed accurately and submitted alongside the appropriate applications and fees to ensure compliance with state regulations. Failure to attach this form or provide correct information may result in the rejection of the entire submission package.
The Texas Department of Public Safety (DPS) form is an essential document for individuals and companies seeking to engage in private security services within the state. This application and fee submission form must be completed accurately and submitted alongside the appropriate fees to ensure a smooth processing experience. It is crucial to use the most current version of the form, as outdated submissions may lead to delays or rejections. Clear and legible printing in black ink is required to avoid any confusion. The form serves multiple purposes, including auditing and verification, making it imperative that all sections are filled out completely. If the form is submitted without the necessary supporting documents or contains errors, the entire application package will be returned. Additionally, the form outlines payment information and includes specific requirements for individuals and companies, such as the collection of a $5 fee for laminated pocket cards. This fee applies to new, renewed, or duplicate cards. By signing the form, applicants affirm that the information provided is accurate and acknowledge the potential consequences of submitting false statements. Proper submission of this form is vital for compliance with Texas regulations and for the successful operation of private security businesses.
Texas Department of Public Safety Regulatory Services Division
www.dps.texas.gov
APPLICATION AND FEE SUBMISSION FORM
• MUST USE MOST CURREN T FORM
PRIVATE SECURITY
• PRI N T CLEARLY I N BLACK I NK
EXAMPLE:
• MAKE SURE ENTI RE CI RCLE I S FI LLED
Yes
No
REQUEST I NFORMATI ON
I understand this form is used for auditing purposes and MUST be submitted with
the proper application(s) and fee(s) .
No
I understand if this form is NOT attached with the supporting documents and / or if
the form is incorrect, the entire package will be returned.
Company
Name
THE ABOVE SPACE I S RESERVED FOR OFFI CE USE ONLY
Company License
Number
PAYMENT I NFORMATI ON
Note: Form examples for an individual and a company are noted in the first two shaded rows of the table below. Fill in each column for your individual(s) and / or company informat ion, as applicable. Companies do not need to include a Social Security Number ( SSN), unless registration is for an individual. Effective October 27 , 2014 , t he Private Security Program will implement Administrative Rule 35.131(b), which requires the collection of a $5 fee for each laminated pocket card. This applies to each new, renewed or duplicate card t hat is produced.
Enclosed in this package are the follow ing:
Check #
SSN
I ndividual OR Company Name
Type of
Transaction
Fee $
(FOR I NDI VI DUALS ONLY)
Registration
Ex. 1010
000-00-0000
John E. Doe
Non-Commissioned
Original
$38
Ex. 200200
n/ a
Just A Sample Security & Alarm Company
Renewal
$412
Total # of Checks Enclosed
Total Amount Enclosed
SI GNER
Signer Last Name
Business Phone
Signer First Name
Business Email
Iverify the information provided is true and correct, and I understand this is an official government record and any false statement made on this document or any other supplement provided to DPS may result in criminal prosecution.
Signature________________________________________________ Date_______________
This form and attachments can be forwarded by mail to:
Texas Department of Public Safety
Private Security MSC 0242
P.O. Box 15999
Austin, Texas 78761 - 5999
PSB-50 (Rev.10/ 2014)
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