SUPPORTING STATEMENT FOR PAPERWORK REDUCTION ACT SUBMISSION
Public Safety Officers’ Benefits (PSOB) Program Applications Package
A. JUSTIFICATION
1. Necessity of Information:
Public Safety Officers’ Death Benefits Application: The U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Assistance’s (BJA) Public Safety Officers’ Benefits (PSOB) Program (42 U.S.C. 3796, et. seq.) provides a one-time benefit to the eligible survivors of local, state, tribal and federal public safety officers whose deaths result from traumatic injuries sustained in the line of duty, or eligible heart attacks, strokes, and vascular ruptures. The Death Application Part A is completed by the applicant. The Death Application Part B is completed by the employing agency. Both applications, along with supporting documentation, are filed with the Bureau of Justice Assistance to assist in evaluating whether claims are eligible under the PSOB Program and, if so, determining the eligibility of spouses, children, PSOB designees, life insurance beneficiaries, parents, and adult children of deceased public safety officers for this benefit.
Public Safety Officers’ Disability Benefits Application: The Public Safety Officers’ Benefits Act of 1976 (PSOB), 42 U.S.C. 3796, authorizes BJA to pay a benefit to applicant public safety officers found to have been permanently and totally disabled as the direct result of a catastrophic line of duty injury sustained on or after November 29, 1990. The Public Safety Officers’ Disability Benefits Application is completed by the applicant (Part A) and the claimant’s former employing public safety agency (Part B). The application and supporting documentation are filed with the PSOB Office.
Public Safety Officers’ Educational Assistance Application: BJA is authorized to administer the Public Safety Officer’s Educational Assistance (PSOEA) Program. Under the PSOEA Act of 1998, Public Law 104-238, Section 1213(a), a person seeking educational benefits through this program must submit an application containing information that is reasonably required. This application has been designed to meet this need. 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.
Public Safety Officers’ Appeal Request Application: BJA provides applicants with the opportunity to appeal a previous Public Safety Officers’ Death or Disability Benefit Determination via an online Public Safety Officer Appeal Request Application. Respondents who complete the application may be disabled public safety officers (disability benefits appeal), or claimants of fallen officers (death benefits appeal), including but not limited to spouses, children, PSOB designees, life insurance beneficiaries, parents, and adult children.
2. Purpose for Use:
Public Safety Officers’ Death Benefits Application: The Public Safety Officer’s Death Benefits Application allows the applicant and agency to assert that the decedent was a public safety officer, and that his or her injury occurred in the line of duty. The Public Safety Officer’s Death Benefits Application lists the officer’s survivors and ensures that eligible beneficiaries are considered for PSOB purposes. The information on these forms is not readily available from sources other than the applicant(s) and former employing agency. Changes to the form have been made in an effort to streamline the application process and eliminate requests for information that is either extraneous or being collected by other means.
Public Safety Officers’ Disability Benefits Application: The information collected is pursuant to the PSOB Act to determine the eligibility of permanently and totally disabled public safety officers for the payment of benefits. The application includes information necessary to determine that the circumstances that lead to the disability meet the requirements established by law. Changes to the form have been made in an effort to streamline the application process and eliminate requests for information that is either extraneous or being collected by other means.
Public Safety Officers’ Educational Assistance Application: This information is collected to confirm the eligibility of applicants seeking PSOEA benefits. Eligibility is dependent on several factors, including the applicant’s having received a portion of the PSOB Death Benefit, or having a spouse or parent who received the PSOB Disability Benefit. Also considered are the applicant’s age (if a child) and the schools attended. The application form has been created in an effort to streamline the application process and eliminate requests for information that is either extraneous or being collected by other means.
Public Safety Officers’ Appeal Request Application: This information is collected to allow claimants to appeal a previous Death or Disability Benefit Determination. The application includes information necessary to determine the validity of the appeal request. Respondents who complete the application may be disabled public safety officers, or claimants of fallen officers, including but not limited to spouses, children, PSOB designees, life insurance beneficiaries, parents, and adult children.
3. Use of Information Technology: All forms will be completed through the PSOB web-based portal available at www.psob.gov. Supporting documentation is also submitted via the portal. Applicants can contact the PSOB Office for assistance toll-free at 1-888-744-6513 or via [email protected].
4. Identification of Duplication:
Public Safety Officers’ Death Benefits Application: This is the only federal program providing this specific service. The Public Safety Officers’ Death Benefits Application is the only form that directly asks the employing agency the information needed to assist in identifying if the decedent was a public safety officer who sustained a line-of-duty injury that caused his or her death. Similarly, the Public Safety Officers’ Death Benefits Application is the only form that directly asks the applicant the information needed to identify survivors who may be eligible to receive the PSOB death benefit, and offsets, if any, that may be implicated if the benefit is approved for payment.
Public Safety Officers’ Disability Benefits Application: This is the only federal program providing this specific service. The PSOB application is the only form that asks the information required to determine if an individual is eligible for the PSOB disability benefit, and offsets, if any, that may be implicated if the benefit is approved for payment.
Public Safety Officers’ Educational Assistance Application: This is the only federal program providing this assistance. The PSOEA application is the only form that asks the information required to determine if an individual is eligible for PSOEA benefits.
Public Safety Officers’ Appeal Request Application: This is the only federal program that allows claimants to appeal a previous determination on a Public Safety Officers’ Death or Disability benefits claim. The Public Safety Officers’ Appeal Request Application is the only form that asks the information required to determine if an individual is eligible to request an appeal.
5. Impact on Small Businesses or Other Entities: The information collection requirements do not impact small businesses or other entities as described in the instructions for completing OMB Form 83-I.
6. Consequences if Collection is not Conducted:
Public Safety Officers’ Death Benefits Application: The Public Safety Officers’ Death Benefits Application is completed once by the applicant and employing agency. Without the statutorily required information collected on the form, BJA would not be able to determine that a public safety officer’s death is the direct and proximate result of an injury sustained in the line of duty, and which applicants (survivors) are eligible, if any, for the PSOB death benefit.
Public Safety Officers’ Disability Benefits Application: The form must be completed only once. Without the statutorily required information collected on the form, BJA would not be able to determine that a public safety officer is totally and permanently disabled as the direct and proximate result of an injury sustained in the line of duty.
Public Safety Officers’ Educational Assistance Application: A completed Public Safety Officers’ Educational Assistance Application need only be submitted once by each new applicant. The information collected on the form is necessary to confirm that the applicant is eligible for PSOEA benefits. Without the needed information, eligibility cannot be determined and consequently no educational assistance payment(s) can be made.
Public Safety Officers’ Appeal Request Application: A completed Public Safety Officers’ Appeal Request Application need only be submitted once by each new claimant. The information collected on the form is necessary to confirm that the applicant is eligible to submit a Public Safety Officers’ Appeal Request Application.
7. Special Circumstances: None.
8. Publication: The application period is open continuously.
9. Payment to Respondents:
Public Safety Officers’ Death Benefits Application: The completion and successful processing of this application will allow eligible beneficiary(ies) of a public safety officer whose death was the direct and proximate result of an injury sustained in the line of duty to receive a one-time, lump sum death benefit of $343,589.00 (current benefit amount FY 2017).
Public Safety Officers’ Disability Benefits Application The completion and successful processing of this application will allow the applicant who is a public safety officer found to be totally and permanently disabled as the direct and proximate result of an injury sustained in the line of duty to receive a one-time, lump sum disability benefit in the amount of $343,589.00 (current benefit amount for FY 2017).
Public Safety Officers’ Educational Assistance Application: The completion and successful processing of this application will allow the applicant, as a beneficiary of a public safety officer who was killed or permanently and totally disabled in the line of duty, to receive up to $1,024.00 per month for full-time attendance (current benefit amount for FY 2017) for educational expenses (i.e. tuition, room and board, books, rent, supplies, etc.) for up to 45 months of full-time assistance.
Public Safety Officers’ Appeal Request Application: The completion and successful processing of this application will allow the applicant to file an administrative appeal of the PSOB Office, or Hearing Officer, determination.
10. Assurance of Confidentiality: All information on these form are collected in accordance with the Privacy Act of 1974, as amended. OJP is compliant with 28CFR22 which protects confidentiality of identifiable and statistical information and is committed to keeping a system of records that is consistent with the regulations of the Privacy Act.
11. Questions of a Sensitive Nature: By their nature, questions addressing the circumstances of officers’ deaths or injuries, their medical backgrounds, and information related to their employing public agencies are inherently sensitive. These inquiries must be made to determine the qualifying factors concerning an officer’s death or disability with regard to eligibility under the Public Safety Officers’ Benefits (PSOB) Program Applications Package.
12. Estimate of the Hour Burden:
Public Safety Officers’ Death Benefits Application:
Number of Respondents: 350
Number of applications submitted per respondent: 1 application
Total annual applications: 350 x 1 = 350
Hours per application: 6 hours
Total Annual Reporting Burden: 350 x 360 minutes per application = 126,000 minutes / by 60 minutes per hour = 2,100 hours.
Public Safety Officers’ Disability Benefits Application:
Annual Hour Burden
Number of Respondents: 100
Number of applications submitted per respondent: 1 application
Total annual applications: 100 x 1 = 100
Hours per application: 5 hours
Total Annual Reporting Burden: 100 x 300 minutes per application = 30,000 minutes / by 60 minutes per hour = 500hours.
Public Safety Officers’ Educational Assistance Application:
Number of Respondents: 200
Number of applications submitted per respondent: 1 application
Total annual applications: 200 x 1 = 200
Hours per application: 0.5 hours
Total Annual Reporting Burden: 200 x 30 minutes per application = 6,000 minutes / by 60 minutes per hour = 100 hours.
Public Safety Officers’ Appeal Request Application:
Number of Respondents: 75
Number of applications submitted per respondent: 1 application
Total annual applications: 75 x 1 = 75
Hours per application: 0.5 hours
Total Annual Reporting Burden: 75 x 30 minutes per application = 2,250 minutes / by 60 minutes per hour = 37.5 hours.
13. Estimate of the Total Annual Cost Burden:
Public Safety Officers’ Death Benefits Application: There is no capital or startup costs associated with information collection under this program. The cost to the respondents is the time (approximately 360 minutes) spent completing the form, gathering the information and transmitting the required documentation.
Public Safety Officers’ Disability Benefits Application: There is no capital or startup costs associated with information collection under this program. The cost to the respondents is the time (approximately 300 minutes) spent completing the form, gathering the information and transmitting the required documentation.
Public Safety Officers’ Educational Assistance Application: There is no capital or startup costs associated with information collection under this program. The cost to the respondents is the time (approximately 30 minutes) spent completing the form, gathering the information and transmitting the required documentation.
Public Safety Officers’ Appeal Request Application: There is no capital or startup costs associated with information collection under this program. The cost to the respondents is the time (approximately 30 minutes) spent completing the form, gathering the information and transmitting the required documentation.
14. Estimates of Annualized Cost to the Federal Government:
Public Safety Officers’ Death Benefits Application: The assigned program manager for this program is paid at an annual rate of a GS-12/5 at $87,664 per year, plus $19,286 (or 22% in fringe benefits) = $106,950 / 52 weeks/40 hours per week equal an hourly rate of $51.4. Each application review takes approximately 360 minutes. $51.41 x 6 hours (360 minutes) = $308.46 per application review.
Public Safety Officers’ Disability Benefits Application: The assigned program manager for this program is paid at an annual rate of a GS-13/5 at $ 87,664 per year, plus $19,286 (or 22% in fringe benefits) = $106,950 /52 weeks/40 hours per week equal an hourly rate of $ 51.41. Each application review takes approximately 300 minutes. $51.41 x 5 hours (300 minutes) = $ 257.05 per application review.
Public Safety Officers’ Educational Assistance Application: The primary program point of contact for PSOEA is paid at an annual rate of a GS-14/3 at $97,936.00 per year, plus $34,276 (or 35% in fringe benefits) = $132,212.00/52 weeks/40 hours per week equal an hourly rate of $63.57. Each application review takes approximately 20 minutes. 200 applications x $21.19 ($63.57/3 = $21.19 per application) = $4,238.00.
Public Safety Officers’ Appeal Request Application:
15. Program Changes or Adjustments: This is a request for a revision of a previously approved collection forms. We are not asking any additional questions from PSOB 1.0 to PSOB 2.0. The change is, we are just automating the process and asking the questions in a different format. In PSOB 1.0 there was a two page application. In PSOB 2.0 we added logic in the system and each question is asked on its on screen, not in application form. Depending on the answer, the applicant will be directed to upload documents to support the answer before moving forward, where as in PSOB 1.0 the applicant was required to upload all documents as an attachment before submitting.
16. Publishing Information: The information collected will not be published.
17. Approval to not Display the OMB Approval: The present information collection request does not seek such an approval.
18. Certification for Paperwork Reduction Act Submission: See attached Certification Statement.
B. STATISTICAL METHODS
Statistical methods will not be used in this information collection.
| File Type | application/msword |
| File Title | SUPPORTING STATEMENT FOR PAPERWORK REDUCTION ACT SUBMISSION |
| Author | presslem |
| Last Modified By | SYSTEM |
| File Modified | 2017-09-26 |
| File Created | 2017-09-26 |