83i

PA PERW ORK REDUCTION A CT SUBM ISSION

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, DC 20503.
1. Agency/Subagency originating request

2. OM B control nu mbe r
a. 1110

DOJ/FBI/CJIS

-

b.

3. Type of information collection (check one)
New collection
a.
Revision of a currently approved collection
b. ✔
c.
Extension, without change, of a currently approved collection
Reinstatement, without change, of a previously approved collection for
d.
which approval has expired
Reinstatement, with change, of a previously approved collection for which
e.
approval has expired
f.
Existing collection in use without an OMB control number

4. Type of review requested (check one)
a. ✔ Regular
Em ergency - A pproval reque sted by:
b.
c.
Delegated

3a. Public C omm ents
Has the agency received public comments on this information collection?

6. Requ ested expiration d ate
a. ✔ Three years from approval date

✔

Yes

None

0058

/

/

5. Small entities
Will this information collection have a significant economic impact on a
Yes
No
substantial number of small entities?

b.

Other Specify:

/

No

7. Title

National Incident-Based Reporting System
8. Agenc y form num ber(s) (if applicable)

UnNumbered
9. Keywords

Incident, Group A offenses, Group B Offenses, Data Elements
10. Abstract

Under Title 28, U.S.C., Sect. 534, this collection requests data from local, state, tribal, and federal law enforcement agencies in
order for the FBI UCR Program to serve as the national clearing house for collection/dissemination of incident data.

11. Affected public (Mark primary with "P" and all others that apply with "X")
a.
b.
c.

d.
F a rm s
e. X Federal Government
f. P State, Local or T ribal Govern men t

Individuals or households
Bus iness or othe r for-pro fit
Not-for-profit institutions

13. Annual reporting and recordkeeping hour burden
a. Num ber of respond ents
b. Total annual responses
1.Percentage of these responses

collected electronically

c. Total annual hours requested
d. Current O MB inventory
e. Difference
f. Explanation of difference
1. Program change
2. Adjustment

12. Obligation to respond (Mark primary with "P" and all others that apply with "X")
a.
b.
c.

P

Voluntary
Required to obtain or retain bene fits
Mand atory

14. Annual reporting and recordkeeping cost burden (in thousands of dollars)
a. Total annualized capital/startup costs
b . T o ta l a nn ua l c os ts (O & M )

c. Total annualized cost requested

d. Current O MB inventory
e. Difference
f. Explanation of difference
1. Program change
2. Adjustment

0

6420
77040

0
0

100
154,080
144,912
9168

%

0
0

0
0

9168

15. Purpose of information collection
others that apply with "X")

a.
Application for be nefits
b.
Program evaluation
c.
General purpose statistics
d.
Aud it

P

(M ark prim ary with "P " an d all
e.
f.
g.

Program planning or management

XResearch
Regulatory or compliance

17. Statistical methods
Does this information collection employ statistical methods?
✔ Yes

OMB 83-I

No

16. Frequency of recordkeeping or reporting (check all that apply)

a.
b.
Reco rdkeeping
Third party disc losure
c. ✔ Reporting
1.
2.
3. ✔ Mo nthly
On occ asion
Wee kly
4.
Quarterly
5.
Sem i-annually 6.
Ann ually
7.
Biennially
8.
Other (de scribe)
18. Agen cy contact (person who can bes t ans we r qu es tion s reg ard ing the c on ten t of this
submission)
Nam e:

Kristi L. Donahue

Phone:

304-625-2972
02/04

19. Certification for Paperwork Reduction Act Submissions
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR
1320.9.

Note:

The text of 5 CFR 1320.9, and the related provisions of 5 CFR 1320.8(b)(3), appear at the end of the instructions.
The certification is to be made with reference to those regulatory provisions as set forth in the instructions.

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous terminology that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f)

It indicates the retention period for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8(b)(3):
(i)

Why the information is being collected;

(ii)

Use of information;

(iii)

Burden estimate;

(iv)

Nature of response (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 the efficient and effective

management and use of the information to be collected (see note in Item 19 of the instructions);

(i)

It uses effective and efficient statistical survey methodology; and

(j)

It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item below and explain the reason in Item 18 of
the Supporting Statement.

Signature of Senior Official or designee

OMB 83-I

Date

02/04