Information Collection

COPS Extension Form

IC 203543 under ICR 201206-1103-003 · OMB 1103-0093.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1103-0093 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
COPS Extension Form	Form and Instruction
COPS Extension Request Form COPS Extension Request Worksheet 2012.doc	Form and Instruction

IC Title:

COPS Extension Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N/A	COPS Extension Request Form	COPS Extension Request Worksheet 2012.doc		No		Paper Only

Line of Business: Law Enforcement

Subfunction: Crime Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,500

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	2,500	2,500
Annual IC Time Burden (Hours)	1,250	1,250
Annual IC Cost Burden (Dollars)	1,250	1,250

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.