Information Collection

Crime Victim Compensation State Certification Form

IC 12438 under ICR 201208-1121-002 · OMB 1121-0170.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0170 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form OJP-7390/5 Crime Victim Compensation State Certification Form	Form
OJP-7390/5 Crime Victim Compensation State Certification Form vc_certification_form01_07.xls	Form

IC Title:

Crime Victim Compensation State Certification Form

Agency IC Tracking Number:

OVC

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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	OJP-7390/5	Crime Victim Compensation State Certification Form	vc_certification_form01_07.xls		No		Paper Only

Line of Business: Income Security

Subfunction: Survivor Compensation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 53

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
	Requested	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	53	-1	54
Annual IC Time Burden (Hours)	53	-1	54
Annual IC Cost Burden (Dollars)	0	0	0

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.