Information Collection

Public Safety Officer Medal of Valor Application

IC 38364 under ICR 200909-1121-002 · OMB 1121-0259.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0259 can be found here:

Documents and Forms

Document Name Document Type
Form OJP-1673/1 Public Safety Officer Medal of Valor Application Form and Instruction
OJP-1673/1 Public Safety Officer Medal of Valor Application for Ext MEDAL OF VALOR APPLICATION.doc www.ojp.usdoj.gov//medalofvalor/welcome.html. Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Public Safety Officer Medal of Valor Application	Agency IC Tracking Number:	BJA

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 28 CFR 22

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	OJP-1673/1	Public Safety Officer Medal of Valor Application for Extraordinary Valor Above and Beyond the Call of Duty	MEDAL OF VALOR APPLICATION.doc	http://www.ojp.usdoj.gov//medalofvalor/welcome.html.	Yes	Yes	Fillable Fileable

Line of Business: Law Enforcement

Subfunction: Leadership Protection

Privacy Act System of Records
Title: Privacy Act 1974	FR Citation: 71 FR 2006

Number of Respondents: 182	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	182	182
Annual IC Time Burden (Hours)	76	76
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.