September 11th Victim Compensation Fund Claimant Registration Form

Forms and Documents

Document Name	Status
Justification for Emergency Approval Request 9 28 11.doc Supplementary Document	2011-09-29
83i PRA_092611.pdf Supplementary Document	2011-09-26
0070.pdf Supplementary Document	2011-09-26
0066-2.pdf Supplementary Document	2011-09-26
0066-1.pdf Supplementary Document	2011-09-26
0056.pdf Supplementary Document	2011-09-26
Supplementary document_0028.pdf Supplementary Document	2011-09-26
supplementary document_0041.pdf Supplementary Document	2011-09-26
911_Updated Supporting Statement PRA_092911.doc Supporting Statement A	2011-09-29

IC Document Collections

IC ID	Document Title	Status
199461	September 11th Victim Compensation Registration Form Other-Screen Shots	New

ICR Details

OMB Control No: 1123-0012	ICR Reference No: 201109-1123-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOJ/CD	Agency Tracking No:
Title: September 11th Victim Compensation Fund Claimant Registration Form
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 10/03/2011
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/29/2011
	Date Received in OIRA: 09/27/2011
Terms of Clearance: Please note the revised emergency justification document in the supplementary documents section. This document serves as the final emergency justification.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2012	6 Months From Approved
Responses	70,000	0	0
Time Burden (Hours)	23,100	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Under the James Zadroga September 11 Health and Compensation Act of 2010 (P.L. 111-347), the Department of Justice would request biographical information and limited information regarding eligibility for the September 11th Victim Compensation Fund from potential claimants in order to begin the process of determining whether claimants will be eligible for compensation from the Fund.

Emergency Justfication: Justification for Emergency Approval Request Emergency approval of the September 11th Victim Compensation Fund Claimant Registration Form is requested given the high-profile and time-sensitive nature of this program. The Attorney General has publicly stated that the Fund will be “up and running” at the beginning of October. Additionally, the Final Rule governing the administration of the Fund, which was published in the Federal Register on August 31, 2011, is effective October 3. Thus, it is important to make the registration form publically available by that time. Delaying the publication of the forms associated with the Victim Compensation Fund will prevent the Department from accomplishing its stated goal of allowing victims to begin to submit claims in October 2011. Meeting this intended start date is consistent with the priorities of the Administration and the Fund’s Special Master. Timeline The PRA review period of 150 days is too long to keep potential claimants waiting to apply for compensation. The following timeline is based on receiving emergency approval of the form. October 3, 2011 Make Registration Form available to the public. October/November 2011 Review Registration Forms and publish remaining parts of claim forms

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Authorizing Statute(s): PL: Pub.L. 111 - 347 404 Name of Law: James Zadroga 9/11 Health and Compensation Act of 2010
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 347 404 Name of Law: James Zadroga 9/11 Health and Compensation Act of 2010

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1105-AB39	Final or interim final rulemaking	76 FR 54112	08/31/2011

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
September 11th Victim Compensation Registration Form

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ICR Summary of Burden

	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	70,000	0	70,000	0	0	0
Annual Time Burden (Hours)	23,100	0	23,100	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement: New Collection.

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Annual Cost to Federal Government:

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

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? 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? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 09/27/2011

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