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Federal forms, ICRs, and supporting documents

Information Collection Request

Report of Public Safety Officers Permanent and Total Disability

ICR 199809-1121-005 · OMB 1121-0166 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
12432 Report of Public Safety Officers Permanent and Total Disability Form Migrated
ICR Details
1121-0166 199809-1121-005
Historical Active 199805-1121-001
DOJ/OJP
Report of Public Safety Officers Permanent and Total Disability
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 11/13/1998
Retrieve Notice of Action (NOA) 09/18/1998
  Inventory as of this Action Requested Previously Approved
02/28/2002 02/28/2002
30 0 0
300 0 0
64,000 0 0
The Public Safety Officers' disability program provides a benefit to Public Safety Officers who have become permanently and totally disabled by a catastrophic injury sustained in the line of duty.
None
None
No
1
IC Title Form No. Form Name
Report of Public Safety Officers Permanent and Total Disability OJP-3650/7
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 30 0 0 30 0 0
Annual Time Burden (Hours) 300 0 0 300 0 0
Annual Cost Burden (Dollars) 64,000 0 0 64,000 0 0
Yes
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
09/18/1998