Information Collection

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

IC 218554 under ICR 201503-1121-003 · OMB 1121-0339.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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/ Coronerâs 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/ Coronerâs 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/ Coronerâs 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 %

table that charts list of burden
	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

table that charts IC Documents
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.