Information Collection

Public Safety Officer Medal of Valor Application

IC 38364 under ICR 201211-1121-004 · OMB 1121-0259.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0259 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form OJP-1673/1 Public Safety Officer Medal of Valor Application for Extraordinary Valor Above and Beyond the Call of Duty Public Safety Officer Medal of Valor Application	Form and Instruction
OJP-1673/1 Public Safety Officer Medal of Valor Application for Ext MEDAL OF VALOR APPLICATION.doc www.ojp.usdoj.gov//medalofvalor/welcome.html.	Form and Instruction

IC Title:

Public Safety Officer Medal of Valor Application

Agency IC Tracking Number:

BJA

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 28 CFR 22

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	OJP-1673/1			http://www.ojp.usdoj.gov//medalofvalor/welcome.html.	Yes	Yes	Fillable Fileable

Line of Business: Law Enforcement

Subfunction: Leadership Protection

Privacy Act System of Records

Title: Privacy Act 1974

FR Citation: 71 FR 2006

Number of Respondents: 176

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	176	-6	182
Annual IC Time Burden (Hours)	73	-3	76
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.

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