Information Collection

Deaths in Custody - Inmate Deaths in State Prisons

IC 219604 under ICR 201601-1121-004 · OMB 1121-0249.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0249 can be found here:

Documents and Forms

Document Name Document Type
Form NPS-4 Deaths in Custody - Inmate Deaths in State Prisons Form and Instruction
NPS-4 Annual Summary of Inmate Deaths in State Prisons 2015 NPS-4 form.pdf Form and Instruction
NPS-4A State Prison Inmate Death Report 2016 NPS-4A Form_2015-10-09.pdf Form and Instruction
Appendix C Attachments A-I.pdf DCRP Appendix IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Deaths in Custody - Inmate Deaths in State Prisons	Agency IC Tracking Number:	BJS

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NPS-4	Annual Summary of Inmate Deaths in State Prisons	2015 NPS-4 form.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	NPS-4A	State Prison Inmate Death Report	2016 NPS-4A Form_2015-10-09.pdf		Yes	Yes	Fillable Fileable

Line of Business: Correctional Activities

Subfunction: Criminal Incarceration

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,646	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,646	3,646
Annual IC Time Burden (Hours)	1,723	1,723
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
DCRP Appendix	Appendix C Attachments A-I.pdf	01/19/2016

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