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Standard Assurances form
OJP Standard Assurance form
OMB: 1121-0140
IC ID: 12418
OMB.report
DOJ/OJP
OMB 1121-0140
ICR 201301-1121-001
IC 12418
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0140 can be found here:
2020-02-11 - Reinstatement without change of a previously approved collection
2016-03-30 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
Standard Assurances form
Form and Instruction
Standard Assurances
OJP_Standard_Assurances_(showing_3_4_2008_revision)_(2)[1].docx
Form and Instruction
OJP Standard Assurances (showing 3 4 2008 revision) (2).pdf
Standard Assurances
IC Document
The change to standard assurances form.doc
explanation for change
IC Document
gms login screen.pdf
GMS login screen shots
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Standard Assurances form
Agency IC Tracking Number:
OGC/OCR
Is this a Common Form?
No
IC Status:
Removed
Obligation to Respond:
Mandatory
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
None
Standard Assurances
OJP_Standard_Assurances_(showing_3_4_2008_revision)_(2)[1].docx
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
General Government
Subfunction:
Central Fiscal Operations
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,000
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
0
0
0
-1,000
1,000
0
Annual IC Time Burden (Hours)
0
0
0
-10,000
10,000
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Standard Assurances
OJP Standard Assurances (showing 3 4 2008 revision) (2).pdf
06/12/2008
explanation for change
The change to standard assurances form.doc
06/12/2008
GMS login screen shots
gms login screen.pdf
11/23/2009
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.