Public Safety Officer Medal of Valor Application

Forms and Documents

Document Name	Status
Form OJP-1673/1 Public Safety Officer Medal of Valor Application Form and Instruction	Removed
Medal of Valor Application Form and Instruction	New
PL 107-12.pdf Supplementary Document	2016-01-12
1121-0259_PSOMV_SupState_011316.doc Supporting Statement A	2016-01-13

IC Document Collections

IC ID	Document Title	Status
38364	Public Safety Officer Medal of Valor Application Form and Instruction	Removed
219566	Medal of Valor Application Form and Instruction	New

ICR Details

OMB Control No: 1121-0259	ICR Reference No: 201601-1121-002
Status: Historical Active	Previous ICR Reference No: 201211-1121-004
Agency/Subagency: DOJ/OJP	Agency Tracking No: BJA
Title: Public Safety Officer Medal of Valor Application
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/25/2016
	Date Received in OIRA: 01/13/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2019	36 Months From Approved	02/29/2016
Responses	107	0	176
Time Burden (Hours)	45	0	73
Cost Burden (Dollars)	0	0	0

---

Abstract: The information collected on this application will provide the nomination of public safety officers for the Public Safety Officer Medal of Valor award. This award will recognize public safety officers who demonstrate courage and bravery above and beyond the call of duty without regard for their personal safety. A Medal of Valor Board (hereinafter referred to as the “Board”), as required by the legislation, was appointed by the President, the Majority and Minority Leaders of the U.S. Senate, and the Speaker and the Minority Leader of the U.S. House of Representatives. The Board shall select candidates as recipients of the Medal of Valor from among those applications received by the National Medal of Valor Office. Not more often than once each year, the Board shall present to the Attorney General the name or names of those it recommends as Medal of Valor recipients.

---

Authorizing Statute(s): PL: Pub.L. 107 - 1 001 Name of Law: Public Safety Officer's Medal of Valor Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 68878	11/06/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 1217	01/11/2016
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Medal of Valor Application	none	Medal of Valor application
Public Safety Officer Medal of Valor Application	OJP-1673/1	Public Safety Officer Medal of Valor Application for Extraordinary Valor Above and Beyond the Call of Duty

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	107	176	0	-69	0	0
Annual Time Burden (Hours)	45	73	0	-28	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The estimated number of applicants decreased.

---

Annual Cost to Federal Government: $1,296

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

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 language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

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

(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.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 01/13/2016

---