Information Collection

Annual Certification Report and Equitable Sharing Agreement

IC 182734 under ICR 201409-1123-001 · OMB 1123-0011.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1123-0011 can be found here:

Documents and Forms

Document Name Document Type
Form OMB Number 1123-00 Annual Certification Report and Equitable Sharing Agreement Form and Instruction
OMB Number 1123-00 Equitable Sharing Agreement and Certification 1123-0011_Form ESAC_3 0 w SnChkBox noSigDt.pdf www.usdoj.gov/criminal/afmls/ Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Annual Certification Report and Equitable Sharing Agreement	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	OMB Number 1123-0011	Equitable Sharing Agreement and Certification	1123-0011_Form ESAC_3 0 w SnChkBox noSigDt.pdf	www.usdoj.gov/criminal/afmls/	Yes	Yes	Fillable Fileable Signable

Line of Business: Law Enforcement

Subfunction: Citizen Protection

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,600	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	7,600	-1,288	8,888
Annual IC Time Burden (Hours)	3,800	-645	4,445
Annual IC Cost Burden (Dollars)	0	0	0

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.