OVC Victim Compensation State Certification form

Community Partnership Grants Management System (GMS)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0243 can be found here:

Documents and Forms

Document Name Document Type
OVC Victim Compensation State Certification form Form
OVC Victi Compensation State Certification form OVC Victim Compensation.pdf www.ojp.gov/gmscbt/ Form
Crime Victim Copensation State Certification Form crime victim compensation state certification form.pdf www.ojp.gov/gmscbt Form
Justification for change on OVC Victim Compensation State Certification form 1121.docx Justification IC Document

Information Collection (IC) Details

IC Title:	OVC Victim Compensation State Certification form	Agency IC Tracking Number:	OAAM

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	OVC Victi Compensation State Certification form	OVC Victim Compensation.pdf	http://www.ojp.gov/gmscbt/	Yes	Yes	Fillable Fileable
Form	n/a	Crime Victim Copensation State Certification Form	crime victim compensation state certification form.pdf	http://www.ojp.gov/gmscbt	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 53	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	53	53
Annual IC Time Burden (Hours)	53	53
Annual IC Cost Burden (Dollars)	4,738	4,738

Documents for IC

Title	Document	Date Uploaded
Justification	Justification for change on OVC Victim Compensation State Certification form 1121.docx	03/23/2017

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.