60 day notice

Department of Justice Billing Code 4410-18

Office of Justice Programs

Bureau of Justice Assistance

Agency Information Collection Activities:

Proposed Collection; Comments Requested

ACTION: 60-Day Notice of Information Collection Under Review: Extension of currently approved collection.

Bureau of Justice Assistance Application Form: Public Safety Officers’ Disability Benefits

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The Department of Justice, Office of Justice Programs, Bureau of Justice Assistance, has submitted the following information collection request for review and clearance in accordance with the Paperwork Reduction Act of 1995. This proposed information collection is published to obtain comments from the public and affected agencies. Comments are encouraged and will be accepted for “sixty days” until [Insert date of the 60th day from the date that this notice is published in the Federal Register]. If you have additional comments or suggestions, or need a copy of the proposed information collection instrument with instructions or additional information, please contact M. Berry at by phone at 202-616-6500 / 1-866-268-0079; by mail at Bureau of Justice Assistance, Office of Justice Programs, U.S. Department of Justice, 810 7th Street, NW., Washington, DC 20531; via facsimile at 202-305-1367; or by e-mail at [email protected].

Written comments and suggestions from the public and affected agencies concerning the proposed collection of information are encouraged. Your comments should do one or more of the following:

- Evaluate whether the proposed collection of information is necessary for the proper performance of the functions of the agency, including whether the information will have practical utility;

- Evaluate the accuracy of the agency’s estimate of the burden of the proposed collection of information, including the validity of the methodology and assumptions used;

- Enhance the quality, utility, and clarity of the information to be collected; and

- Minimize the burden of the collection of information on those who are to respond, including through the use of appropriate automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g., permitting electronic submission of responses.

Overview of this information collection:

(1) Type of information collection: Extension of currently approved collection.

(2) The title of the form/collection: OJP FORM 3650/7 Public Safety Officers’ Disability Benefits.

(3) The agency form number, if any, and the applicable component of the Department sponsoring the collection: None. Bureau of Justice Assistance, Office of Justice Programs, United States Department of Justice.

(4) Affected public who will be asked or required to respond, as well as a brief abstract:

Primary: Dependents of public safety officers who were killed or permanently and totally disabled in the line of duty.

Abstract: BJA=s Public Safety Officers= Benefits (PSOB) Office will use the PSOB Disability Application information to confirm the eligibility of applicants to receive Public Safety Officers= Education Assistance Benefits. Eligibility is dependent on several factors, including the applicant having received or being eligible to receive a portion of the PSOB Death Benefit, or having a family member who received the PSOB Disability Benefit. Also considered are the applicant=s age and the schools being attended. In addition, information to help the PSOB Office identify an individual is collected, such as Social Security number and contact numbers and e-mail addresses. The changes to the application form have been made in an effort to streamline the application process and eliminate requests for information that are either irrelevant or already being collected by other means.

Others: None.

(5) An estimate of the total number of respondents and the amount of time needed for an average respondent to respond is as follows: It is estimated that no more than 100 respondents will apply a year. Each application takes approximately 120 minutes to complete.

(6) An estimate of the total public burden (in hours) associated with the collection: Total Annual Reporting Burden: 100 x 120 minutes per application = 12,000 minutes / by 60 minutes per hour = 200 hours.

If additional information is required, please contact the Clearance Officer, United States Department of Justice, Justice Management Division, Policy and Planning Staff, Patrick Henry Building, Suite 1600, 601 D Street NW., Washington, DC 20530.

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Clearance Officer Date

Justice Management Division

United States Department of Justice

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