Certification of Compliance with the Statutory Eligibility Requirements of the Violence Against Women Act as Amended

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1122-0001 Certification of Compliance with the Statutory Eligibility Requirements of the Violence Against Women Act as Amended	Form	Modified	Available
ombrocis2015NEWSTOPCERTsupportstatement.doc	Supporting Statement A	Uploaded 2015-12-14	Available
42 U_S_ Code § 3796gg–8 - Polygraph testing prohibition US Law LII - Legal Information Institute.mht	Supplementary Document	Uploaded 2015-11-25	Available
42 U_S_ Code § 3796gg–5 - Costs for criminal charges and protection orders US Law LII - Legal Information Institute.mht	Supplementary Document	Uploaded 2015-11-25	Available
42 U_S_ Code § 3796gg–4 - Rape exam payments US Law LII - Legal Information Institute.mht	Supplementary Document	Uploaded 2015-11-25	Available
42 U_S_ Code § 3796gg - Purpose of program and grants US Law LII - Legal Information Institute.mht	Supplementary Document	Uploaded 2015-11-25	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
12639	Certification of Compliance with the Statutory Eligibility Requirements of the Violence Against Women Act as Amended	Form	Modified

ICR Details

OMB Control No: 1122-0001	ICR Reference No: 201312-1122-001
Status: Historical Active	Previous ICR Reference No: 201211-1122-001
Agency/Subagency: DOJ/OVW	Agency Tracking No: 1122-0001
Title: Certification of Compliance with the Statutory Eligibility Requirements of the Violence Against Women Act as Amended
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/16/2016
	Date Received in OIRA: 12/14/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2019	36 Months From Approved	02/29/2016
Responses	56	0	56
Time Burden (Hours)	56	0	56
Cost Burden (Dollars)	0	0	0

---

Abstract: This information is necessary for OVW to determine that grantees under the STOP Violence Against Women Formula Grant Program comply with the statutory eligibility requirements of the Violence Against Women Act as amended by the recent re-authorization of the Violence Against Women Act.

---

Authorizing Statute(s): US Code: 42 USC 3796gg Name of Law: Violence Against Women Act (VAWA) of 1994
  

Citations for New Statutory Requirements: US Code: 42 USC 3796gg-1-5 Name of Law: Violence Against Women Act of 1994, as amended
US Code: 42 USC 3796gg-8 Name of Law: Violence Against Women Act of 1994, as amended
US Code: 42 USC 3796gg Name of Law: Violence Against Women Act of 1994, as amended

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 50873	08/21/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 65804	10/27/2015
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Certification of Compliance with the Statutory Eligibility Requirements of the Violence Against Women Act as Amended	1122-0001	Certification of Compliance with the Statutory Eligibility

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	56	56	0	0	0	0
Annual Time Burden (Hours)	56	56	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $3,136

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/14/2015

---