Law Enforcement Officers Safety Act (LEOSA) Photographic Identification Card Application

ICR 202108-1405-002 · OMB 1405-0245 · Received in OIRA

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 1405-0245 can be found here:

Forms and Documents

Document	Type	Status	Availability
Law Enforcement Officers Safety Act (LEOSA) Photographic Identification Card Application	Form and Instruction	New	Repair queued
legalAuthorities - LEOSA.docx	Supplementary Document	Uploaded 2021-08-10	Repair queued
Supporting Statement_LEOSA.docx	Supporting Statement A	Uploaded 2021-08-10	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
248797	Law Enforcement Officers Safety Act (LEOSA) Photographic Identification Card Application	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202108-1405-002
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Law Enforcement Officers Safety Act (LEOSA) Photographic Identification Card Application
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 08/26/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	70	0
Time Burden (Hours)	70	0
Cost Burden (Dollars)	1,758	0

Abstract: This collection is necessary in order for DS to process and issue the photographic identification cards (LEOSA Identification Cards) as specified under 18 U.S.C. § 926C (The Law Enforcement Officers Safety Act of 2004 (LEOSA), as amended).

Authorizing Statute(s): US Code: 18 USC 926C Name of Law: Carrying of Concealed Firearms by Qualified Retired Law Enforcement Officers

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 24133	05/05/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 40225	07/27/2021
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Law Enforcement Officers Safety Act (LEOSA) Photographic Identification Card Application	NA	Law Enforcement Officers Safety Act Photographic ID Application

ICR Summary of Burden

	Total Request	Change Due to Agency Discretion
Annual Number of Responses	70	70
Annual Time Burden (Hours)	70	70
Annual Cost Burden (Dollars)	1,758	1,758

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: New collection; updated burden tables.

Annual Cost to Federal Government: $15,124

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Elizabeth Twerdahl 571 345-2187

Common Form ICR: No