REPORT OF PUBLIC SAFETY OFFICER'S DEATH

ICR 197801-1121-002

OMB: 1121-0025

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
168039 Migrated
ICR Details
1121-0025 197801-1121-002
Historical Active 197711-1121-004
DOJ/OJP
REPORT OF PUBLIC SAFETY OFFICER'S DEATH
No material or nonsubstantive change to a currently approved collection   No
Emergency 01/31/1978
Approved with change 01/31/1978
Retrieve Notice of Action (NOA) 01/31/1978
  Inventory as of this Action Requested Previously Approved
12/31/1981 12/31/1981 12/31/1981
600 0 600
3,000 0 3,000
0 0 0

P.L. 94-430, THE PUBLIC SAFETY OFFICERS' BENEFITS ACT OF 1976, AUTHORIZES LEAA TO PAY A DEATH BENEFIT TO ELIGIBLE SURVUVORS OF PUBLIC SAFETY OFFICERS WHO DIE IN THE LINE OF DUTY. FORM DETERMINES ELIGIBILITY THROUGH PROVIDING INFORMATION CONCERNING DECEDENT, HIS FAMILY AND CIRCUMSTANCES OF DEATH.

None
None


No

1
IC Title Form No. Form Name
REPORT OF PUBLIC SAFETY OFFICER'S DEATH LEAA 3650/2, OJARS 3650/2

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 600 600 0 0 0 0
Annual Time Burden (Hours) 3,000 3,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
01/31/1978


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