OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Report of Public Safety Officers' Permanent and Total Disability

ICR 200608-1121-006 · OMB 1121-0166 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form OJP form 3650/7 Report of Public Safety Officers' Permanent and Total Disability Form Modified Available
PSOB DISABILITY JUSTIFICATION 2006 REVISED.doc Supporting Statement A Uploaded 0000-00-00 Available
PSOB LEGISLATION.pdf Supplementary Document Uploaded 1988-10-01 Available
IC Document Collections
IC IDCollectionTypeStatusForm
12434 Report of Public Safety Officers' Permanent and Total Disability Form Modified
ICR Details
1121-0166 200608-1121-006
Historical Active 200404-1121-002
DOJ/OJP None
Report of Public Safety Officers' Permanent and Total Disability
Revision of a currently approved collection   No
Regular
Approved without change 05/29/2007
Retrieve Notice of Action (NOA) 04/18/2007
  Inventory as of this Action Requested Previously Approved
05/31/2010 36 Months From Approved 05/31/2007
75 0 45
188 0 90
0 0 0
The information collected is pursuant to the Public Safety Officers' Benefit Act of 1976 to determine the eligibility of permanently and totally disabled public safety officers for the payment of benefits. The form includes information necessary to determine that the circumstances that lead to the disability meet the requirements prescribed in 42 U.S.C. Sec. 3796.
US Code: 42 USC 3796 Section 1201 Name of Law: Public Safety Officers’ Benefits Act of 1976
  
None
Not associated with rulemaking
  72 FR 7677 02/16/2007
72 FR 18670 04/13/2007
No
1
IC Title Form No. Form Name
Report of Public Safety Officers' Permanent and Total Disability OJP form 3650/7 Public Safety Officer's Benefits Program
  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 75 45 0 30 0 0
Annual Time Burden (Hours) 188 90 0 98 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
Increase in applicants after September 11, 2001 terrorist attack.
$9,639
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Maria Pressley 202-353-8643 [email protected]
  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.
04/18/2007