Information Collection

Survey of Inmates in Local Jails Instrument Pretest

IC 240420 under ICR 201902-1121-003 · OMB 1121-0339.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0339 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Survey of Inmates in Local Jails Instrument Pretest	Form and Instruction
SILJ Draft Instrument Appendix A - SILJ Pretest Instrument.docx	Form and Instruction
OMB memo_SILJ Pretest.docx Memo to OMB for SILJ Pretest	IC Document
Appendix B - SILJ Pretest Consent Form.docx Appendix B Consent Form	IC Document
Appendix C - Recruitment Letter from Director of BJS.docx Appendix C Recruitment Letter	IC Document
Appendix D - Non-interview Worksheet.docx Appendix D Noninterview Worksheet	IC Document
Appendix E - SILJ Privacy Certificate.pdf Appendix E Privacy Certificate	IC Document
Appendix F -Institutional_Review_Board_Notice_of_Approval_study_modification.pdf Appendix F IRB Approval	IC Document

IC Title:

Survey of Inmates in Local Jails Instrument Pretest

Agency IC Tracking Number:

BJS

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N/A	SILJ Draft Instrument	Appendix A - SILJ Pretest Instrument.docx		Yes	Yes	Fillable Fileable

Line of Business: Correctional Activities

Subfunction: Criminal Incarceration

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 370

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	370	370
Annual IC Time Burden (Hours)	587	587
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Memo to OMB for SILJ Pretest	OMB memo_SILJ Pretest.docx	03/05/2020
Appendix B Consent Form	Appendix B - SILJ Pretest Consent Form.docx	03/05/2020
Appendix C Recruitment Letter	Appendix C - Recruitment Letter from Director of BJS.docx	03/05/2020
Appendix D Noninterview Worksheet	Appendix D - Non-interview Worksheet.docx	03/05/2020
Appendix E Privacy Certificate	Appendix E - SILJ Privacy Certificate.pdf	03/05/2020
Appendix F IRB Approval	Appendix F -Institutional_Review_Board_Notice_of_Approval_study_modification.pdf	03/05/2020

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