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pdfPAPERWORK REDUCTION ACT SUBMISSION
Please read the instructions before completing this form. For additional forms or assistance in completing this form, contact your agency's Paperwork
Clearance Officer. Send two copies of this form, the collection instrument to be reviewed, the Supporting Statement, and any additional documentation
to: Office of Information and Regulatory Affairs, Office of Management and Budget, Docket Library, Room 10102, 725 17th Street NW,
Washington, DC20503.
1.Agency/Subagency originating request
a.
FBI/CJIS
3.Type ofinformation collection (check one)
a. • New Collection
b. QJ Revision of acurrently approved collection
c. [/] Extension of acurrently approved collection
d. Q Reinstatement, without change, of a previously approved
collection forwhich approval has expired
e. LJ Reinstatement, withchange, ofa previously approved
1110
Existing collection in use without an OMB control number
For b-f, note Item A2ofSupporting Statement instructions
None
. 0061
4. Type of review requested (check one)
a. [TJ Regular
b. LJ Emergency - Approval requested by:
_/
t
c. I IDelegated
5. Small entities
Will this information collection have a significant economic impact ona
substantial number of small entities?
collection for which approval has expired
f. •
b. •
2. OMB control number
Yes D
No
EJ
6. Requested expirationdate
a. E3 Three years from the approval date
b. J. J
7. Title
Request to Change lll/NGI Base Identifier(s)
8. Agency form number(s) (if applicable)
1-542
9. Keywords
Change lll/NGI Identifier(s)
10. Abstract
DOJ's CJIS is requesting a PRA extension ofa currently approved collection. The 1-542 is utilized to provide authorized agencies a consistent format tosubmit
identity history information.
11. Affected public (Mark primary with "P" and all others with "X")
a. _ Individuals or households
d. __ Farms
b. ._ Business or other for-profit
e. P Federal Government
_ Not-for-profit institutions
f. P State, Local, orTribal Government
13.Annual reporting and recordkeeping hour burden
a. Number ofrespondents
b. Total annual responses
114,000
114,000
1. Percentageofthese responses
collected electronically
N/A
12. Obligation to respond (Mark primary with "P" and all others that apply with "X")
a. [P] Voluntary
b. Q Required to obtain or retain benefits
c. I IMandatory
14. Annual reporting andrecordkeeping costburdenf/n thousands ofdollars)
a. Total annualized capital/startup costs
N/A
b.Total annual costs (O&M)
443,976.00
c. Total annualized cost requested
N/A
d. Current OMB inventory
c. Total annual hours requested
28,500
e. Difference
d. Current OMB inventory
0
f. Explanation of difference
e. Difference
N/A
f. Explanation of difference
1. Program change
N/A
2. Adjustment
N/A
15.Purpose ofinformation collection (Mark primary with "P" and allothers
that apply with "X"'J
1. Program change
N/A
2. Adjustment
N/A
6. Frequency ofrecordkeeping orreporting (check all that apply)
a. 0 Recordkeeping
a. _ Application for benefits
e. _, Program planning ormanagement c. |~~l Reporting:
b. _ Program evaluation
f._ Research
c. _ General purpose statistics g. P_ Regulatory or compliance
d. _ Audit
N/A
b. •
Third party disclosure
1.
On occasion
2. •
Weekly
4.
7.
Quarterly
Biennially
5.
8.
Semi-annually 6. • Annually
Other (describe)
3.
Olonthly
18. Agency contact (person who can best answer questions regarding the content
17. Statistical methods
Doesthisinformation collection employ statistical methods?
YesQ No [7]
of this submission)
Name: Gerry Lynn Brovey, Supervisory Information LiaisonSpecialist
Pnone: (304)625-4320
OMB 83-I
10/95
19. Certification for Paperwork Reduction Act Submissions
On behalf ofthis Federal agency, Icertify that the collection ofinformation encompassed by this request complies with
5 CFR 1320.9.
NOTE: The text of5 CFR 1320.9, andthe related provisions of5 CFR 1320.8(b)(3), appear at theendofthe
instructions. The certification is tobemade with reference tothose regulatory provisions as set forth in
the instructions.
Thefollowing is a summary ofthe topics, regarding the proposed collection of information, thatthe certification covers:
(a) Itis necessary forthe properperformance of agency functions;
(b) Ifavoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language thatis understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) Itindicates the retention periods for recordkeeping requirements;
(g) Itinforms respondents ofthe information called for under5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature ofresponse (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 theefficient and effective manage
ment and use ofthe information to be collected (see note in Item 19 ofthe instructions);
(i) Ituses effective and efficient statistical survey methodology (if applicable); and
(J) Itmakesappropriate use of information technology.
If you are unable to certify compliance with any ofthese provisions, identify the item below and explain the reason in
Item 18 of the Supporting Statement.
Signature of Senior Official or designee
Date
(rfjUU~Ai(c&<~Q/tp*| File Type | application/pdf |
| File Modified | 2015-06-08 |
| File Created | 2015-06-08 |