Information Collection

Crime victim Compensation State Certification Form

IC 204493 under ICR 201210-1121-001 · OMB 1121-0170.

Documents and Forms

Document Name Document Type
Form OJP-7390/5 Crime victim Compensation State Certification Form Form
OJP-7390/5 Crime Victim Compensation State Certification Form Copy of Copy of vc_certification_form01_07Updated.xls Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Crime victim Compensation State Certification Form	Agency IC Tracking Number:	OVC

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	OJP-7390/5	Crime Victim Compensation State Certification Form	Copy of Copy of vc_certification_form01_07Updated.xls	none	No		Paper Only

Line of Business: Income Security

Subfunction: Survivor Compensation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 53	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	53	53
Annual IC Time Burden (Hours)	53	53
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.