Information Collection

COPS Customer Outreach and Information Sample

IC 202168 under ICR 201311-1103-001 · OMB 1103-0109.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Question Bank Screenshots 2.9.12.pdf	Other-Questions answered electronica
COPS Success Story Template Collection Instrument_2013 SUCCESS STORY TEMPLATE to OMB 11 13 13.docx	Form and Instruction
Explanation for Generic IC Burden Worksheet for additional questions to Question Bank 2.17.12.docx Explanation for Generic IC Burden Hours	IC Document
Explanation for Generic IC Burden Worksheet for additional questions to Question Bank 11.19.13.docx Explanation for No Burden Increase	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: Modified

Obligation to Respond: Voluntary

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
Other-Questions answered electronically			Question Bank Screenshots 2.9.12.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	N/A	COPS Success Story Template	Collection Instrument_2013 SUCCESS STORY TEMPLATE to OMB 11 13 13.docx		Yes	Yes	Fillable Printable

Line of Business: Law Enforcement

Subfunction: Crime Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

Number of Respondents for Small Entity: 300

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	250	250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Explanation for Generic IC Burden Hours	Explanation for Generic IC Burden Worksheet for additional questions to Question Bank 2.17.12.docx	05/07/2012
Explanation for No Burden Increase	Explanation for Generic IC Burden Worksheet for additional questions to Question Bank 11.19.13.docx	11/21/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.