Information Collection

Rap Back Services Form 1-796

IC 215135 under ICR 201502-1110-004 · OMB 1110-0067.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1110-0067 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1-796 Rap Back Services Form 1-796	Form and Instruction
1-796 Rap Back Services Form 1-796 Non-Fillable.pdf	Form and Instruction
1-796 (Fillable) Rap Back Services Form 1-796 Fillable.pdf	Form and Instruction

IC Title:

Rap Back Services Form 1-796

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 28 CFR 50.12(a) 28 CFR 0.85(j) 28 CFR 20.33(a)(3)

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
Form and Instruction	1-796	Rap Back Services Form	1-796 Non-Fillable.pdf		No		Printable Only
Form and Instruction	1-796 (Fillable)	Rap Back Services Form	1-796 Fillable.pdf		No		Fillable Printable

Line of Business: Law Enforcement

Subfunction: Crime Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 120,000

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6,000	6,000
Annual IC Time Burden (Hours)	300	300
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.