Information Collection

Congressional Badge of Bravery

IC 209119 under ICR 202005-1121-003 · OMB 1121-0330.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0330 can be found here:

Documents and Forms

Document Name Document Type
Congressional Badge of Bravery Form
Congressional Badge of Bravery application cbob-application.jpg Form
completion page complete.jpg Form
event form page event-form.jpg Form
nominator form page nominator-form.jpg Form
nominee form page nominee-form.jpg Form
supporting form page supporting-form.jpg Form
thanks page thanks.jpg Form
witness page witness-form.jpg Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Congressional Badge of Bravery	Agency IC Tracking Number:	BJA

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	witness page	witness-form.jpg	Yes	Yes	Fillable Fileable
Form	none	Congressional Badge of Bravery application	cbob-application.jpg	Yes	Yes	Fillable Fileable
Form	none	completion page	complete.jpg	Yes	Yes	Fillable Fileable
Form	none	event form page	event-form.jpg	Yes	Yes	Fillable Fileable
Form	none	nominator form page	nominator-form.jpg	Yes	Yes	Fillable Fileable
Form	none	nominee form page	nominee-form.jpg	Yes	Yes	Fillable Fileable
Form	none	supporting form page	supporting-form.jpg	Yes	Yes	Fillable Fileable
Form	none	thanks page	thanks.jpg	Yes	Yes	Fillable Fileable

Line of Business: Law Enforcement

Subfunction: Leadership Protection

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 164	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	164	164
Annual IC Time Burden (Hours)	55	55
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.