Application for Public Safety Officers' Educational Assistance

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
2017-18288.pdf	Supplementary Document	Uploaded 2017-09-26	Available
2017-12778.pdf	Supplementary Document	Uploaded 2017-09-26	Available
Supporting Statement 2 - PSOB Program.doc	Supporting Statement A	Uploaded 2017-09-26	Available
PSOB_LEGISLATION.pdf	Supplementary Document	Uploaded 2013-07-26	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
227413	Public Safety Officers' Appeal Request Application	Other-questions	New
227412	Public Safety Officers' Disability Beneftis Application	Other-questions	New
227411	Public Safety Officers' Death Benefits Application	Other-questions	New
12501	Application for Public Safety Officers' Educational Assistance	Other-questions	Modified

ICR Details

OMB Control No: 1121-0220	ICR Reference No: 201707-1121-002
Status: Historical Active	Previous ICR Reference No: 201701-1121-001
Agency/Subagency: DOJ/OJP	Agency Tracking No: BJA
Title: Application for Public Safety Officers' Educational Assistance
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/02/2017
	Date Received in OIRA: 08/30/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2020	36 Months From Approved	03/31/2020
Responses	725	0	150
Time Burden (Hours)	2,738	0	50
Cost Burden (Dollars)	0	0	0

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Abstract: The agency requires the information requested on this application to determine if individuals are eligible to receive educational assistance through the Public Safety Officers' Educational Assistance (PSOEA) Program, as established by the PSOEA Act of 1998 (P.L. 104-238). Respondents who complete the application may be spouses or eligible children of public safety officers who were killed or permanently and totally disabled in the line of duty.

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Authorizing Statute(s): PL: Pub.L. 104 - 238 1211 Name of Law: Public Safety Officer's Benefits
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 28094	06/20/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 41056	08/29/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Application for Public Safety Officers' Educational Assistance
Public Safety Officers' Death Benefits Application
Public Safety Officers' Disability Beneftis Application
Public Safety Officers' Appeal Request Application

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ICR Summary of Burden

table that charts list 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	725	150	0	575	0	0
Annual Time Burden (Hours)	2,738	50	0	2,688	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: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The increase in burden is due to the changing forms for this collection. We have combined forms and added one form.

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Annual Cost to Federal Government:

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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

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Common Form ICR:  No

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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: 08/30/2017

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