Pilot test of new methodology under the Arrest-Related Deaths (ARD) Program

Generic Clearance for Cognitive, Pilot and Field Studies for Bureau of Justice Statistics Data Collection Activities

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0339 can be found here:

Documents and Forms

Document Name Document Type
Form CJ-11 Pilot test of new methodology under the Arrest-Related Deaths (ARD) Program Form and Instruction
CJ-11 Arrest-related Deaths Quarterly Summary for Law Enforcem Attch-A_CJ-11_LEA.pdf Form and Instruction
CJ-11s Arrest-related Deaths Quarterly Summary (sample) for Law Attch-B_CJ-11s_LEA_Sample.pdf Form and Instruction
CJ-11A Arrest-related Death Incident Report for Law Enforcement Attch-C_CJ-11A_LEA_Addendum.pdf Form and Instruction
CJ-12 Arrest-related Deaths Quarterly Summary for Medical Exam Attch-D_CJ-12_ME-C.pdf Form and Instruction
CJ-12s Arrest-related Deaths Quarterly Summary (sample) for Med Attch-E_CJ-12s_ME-C_Sample.pdf Form and Instruction
CJ-12A Arrest-related Death Incident Report for Medical Examine Attch-F_CJ-12A_ME-C_Addendum.pdf Form and Instruction
ARD Pilot Test OMB Generic Clearance Memo.docx OMB Memo to conduct a pilot test of the Arrest-Related Deaths Program (ARD) IC Document
Appendix G_N_ARD Pilot State Contact Ltr.pdf All other attachments to support ARD Pilot Test IC Document

Information Collection (IC) Details

IC Title:	Pilot test of new methodology under the Arrest-Related Deaths (ARD) Program	Agency IC Tracking Number:	BJS

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CJ-11	Arrest-related Deaths Quarterly Summary for Law Enforcement Agencies	Attch-A_CJ-11_LEA.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CJ-11s	Arrest-related Deaths Quarterly Summary (sample) for Law Enforcement Agencies	Attch-B_CJ-11s_LEA_Sample.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CJ-11A	Arrest-related Death Incident Report for Law Enforcement Agencies	Attch-C_CJ-11A_LEA_Addendum.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CJ-12	Arrest-related Deaths Quarterly Summary for Medical Examiner/ Coroner’s Offices	Attch-D_CJ-12_ME-C.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CJ-12s	Arrest-related Deaths Quarterly Summary (sample) for Medical Examiner/ Coroner’s Offices	Attch-E_CJ-12s_ME-C_Sample.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CJ-12A	Arrest-related Death Incident Report for Medical Examiner/ Coroner’s Offices	Attch-F_CJ-12A_ME-C_Addendum.pdf	Yes	Yes	Fillable Fileable

Line of Business: Law Enforcement

Subfunction: Crime Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,705	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 90 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,705	1,705
Annual IC Time Burden (Hours)	842	842
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Memo to conduct a pilot test of the Arrest-Related Deaths Program (ARD)	ARD Pilot Test OMB Generic Clearance Memo.docx	10/13/2015
All other attachments to support ARD Pilot Test	Appendix G_N_ARD Pilot State Contact Ltr.pdf	10/14/2015

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