LEO Reimbursement Request Form

Law Enforcement Officer (LEO) Reimbursement Request

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1652-0063 can be found here:

Documents and Forms

Document Name Document Type
LEO Reimbursement Request Form Form and Instruction
LEO Reimbursement Request LEO Reimbursement Form.docx Form and Instruction

Information Collection (IC) Details

IC Title:	LEO Reimbursement Request 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: 49 CFR 106 (f)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	LEO Reimbursement Request	LEO Reimbursement Form.docx		Yes	Yes	Fillable Printable

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 326	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 75 %

	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	3,912	3,912
Annual IC Time Burden (Hours)	3,912	3,912
Annual IC Cost Burden (Dollars)	1,721	1,721

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.