State Correction Incident Report

Death in Custody Reporting Act

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0365 can be found here:

Documents and Forms

Document Name Document Type
State Correction Incident Report Form
State Correction Incident Report DCR-1A Death Report.pdf Form

Information Collection (IC) Details

IC Title:	State Correction Incident Report	Agency IC Tracking Number:	BJA

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	State Correction Incident Report	DCR-1A Death Report.pdf	TBD	Yes	Yes	Fillable Fileable

Line of Business: Law Enforcement

Subfunction: Leadership Protection

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 56	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,954	4,954
Annual IC Time Burden (Hours)	1,239	1,239
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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