Form 1121-NEW Tally Sheet for FIST Purchase Permit Statistics

OMB No. XXXX-XXXX: Approval Expires XX/XX/XXXX

Please return by July 31, 2007

Tally Sheet for FIST Purchase Permit Statistics (January - June 2007)

«ORI» «Company»

	January	February	March	April	May	June	Total
Applications
Rejections
		Reasons for Rejection (if known)
Felony Indicted
Felony Conviction
Felony No Disp.
Fugitive
Juvenile
Drug Related
Court Order
Mental Incompetence
Illegal Alien
State Law
Local Ordinance
Domestic Violence
Other*
		Arrest and Appeal Information**
Number of Arrests
Reconsiderations† Received
Reconsiderations Reversed
Appeals to Court Filed
Appeals to Court Reversed

*Other includes dishonorable discharge, renunciation of U.S. citizenship, and unspecified reasons.

**Arrest and appeal counts can be sent later, if more time is needed to collect data.

† A reconsideration occurs when the denied person objects to the original decision and asks your agency to

reconsider the denial.

If these statistics cover only part of a month, please enter the last date these statistics cover:___________________

Please fill in at least the first two rows and fax or mail this form back to us as soon as possible. Even if your agency received zero (0) applications, please send this information. If your agency does not maintain monthly data, please provide the total (or cumulative) statistics for the six months.

Thank You! For any questions: 1-800-531-2150 FAX: (314) 535-1729

Completed By: ­­­­­­­­­­­­­­­­­_______________________

Telephone: __­­­­­­­­­­­­­­­­­­_____________________ MAIL: FIST – REJIS

FAX:­­­­­­­­­­­ _______________________ 4255 West Pine Blvd.

E-mail: ______________________________ St. Louis, MO 63108

Burden statement

Federal agencies may not conduct or sponsor an information collection, and a person is not required to respond to a collection of information, unless it displays a currently valid OMB Control Number. Public reporting burden for this collection of information is estimated to average thirty minutes per response, including time for reviewing instructions, searching existing data sources, gathering an maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate, or any other aspects of this collection of information, including suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, 810 Seventh Street NW, Washington, DC 20531. The Omnibus Crime Control and Safe Streets Act of 1968, as amended (42 USC 3732), authorizes this information collection. Although this survey is voluntary, we urgently need and appreciate your cooperation to make the results comprehensive, accurate, and timely.