COPS Extension Form

COPS Extension Request Form

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
COPS Extension Form Form and Instruction
COPS Extension Request Form COPS Extension Request Worksheet 2012.doc Form and Instruction

Information Collection (IC) Details

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:

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 %

	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

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.