OMB
.report
Search
Deaths in Custody Reporting Program
Deaths in Custody -- series of collections from local jails, State prisons and juvenile detention centers, and law enforcement
OMB: 1121-0249
IC ID: 204168
OMB.report
DOJ/OJP
OMB 1121-0249
ICR 201308-1121-002
IC 204168
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0249 can be found here:
2021-05-12 - No material or nonsubstantive change to a currently approved collection
2019-02-04 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form NPS-4; NPS-4A
Deaths in Custody Reporting Program
Form and Instruction
NPS-4; NPS-4A Deaths in Custody, 2012 Annual Summary of Inmate Deaths
DCRP-prisons 2012 ASF form and 2013 death form.pdf
Form and Instruction
CJ-9A/CJ-10A 2013 Annual Summary on Inmates Under Jail Jurisdiction
Appendix_C_2013 CJ-9A_10A.pdf
Form and Instruction
CJ-11; CJ-11A Arrest-Related Deaths Summary of Incidents, 2013; Arrest
DCRP-ARD 2013 summary and death forms.pdf
Form and Instruction
Appendix C Attachments A-J.pdf
Appendix C - All Attachments
IC Document
DCRP Web Form Screen Shots.docx
Draft Screen Shots for Prisons and Jails Web Form
IC Document
jail letter with confidentiality assurances_OMB 2012.doc
Example of Cover Letter with Confidentiality Assurance
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Deaths in Custody Reporting Program
Agency IC Tracking Number:
BJS
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
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
NPS-4; NPS-4A
Deaths in Custody, 2012 Annual Summary of Inmate Deaths in State Prisons and 2013 State Prison Inmate Death Report
DCRP-prisons 2012 ASF form and 2013 death form.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
CJ-9A/CJ-10A
2013 Annual Summary on Inmates Under Jail Jurisdiction
Appendix_C_2013 CJ-9A_10A.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
CJ-11; CJ-11A
Arrest-Related Deaths Summary of Incidents, 2013; Arrest-Related Deaths Incident Report, 2013; and Question by Question Guide for CJ-11A
DCRP-ARD 2013 summary and death forms.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Correctional Activities
Subfunction:
Criminal Incarceration
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
11,308
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
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
11,308
0
0
0
0
11,308
Annual IC Time Burden (Hours)
7,726
0
3,597
0
0
4,129
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Appendix C - All Attachments
Appendix C Attachments A-J.pdf
09/21/2012
Draft Screen Shots for Prisons and Jails Web Form
DCRP Web Form Screen Shots.docx
09/21/2012
Example of Cover Letter with Confidentiality Assurance
jail letter with confidentiality assurances_OMB 2012.doc
12/18/2012
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.