83i

PAPERWORK REDUCTION ACT SUBMISSION

Please read the instructions before completing this form. For additional forms or assistance in completing this form, contact your agency's Paperwork
Clearance Officer. Send two copies of this form, the collection instrument to be reviewed, the Supporting Statement, and any additional documentation
to: Office of Information and Regulatory Affairs, Office of Management and Budget, Docket Library, Room 10102, 725 17th Street NW,
Washington, DC 20503.
1. Agency/Subagency originating request

2. OMB control number

b.

None

1110
__ __ __ - __0043
__ __ __
a. __ __

DOJ/FBI
3. Type of information collection (check one)

__ __ __ __

4. Type of review requested (check one)

a.

New Collection

a. ✔ Regular

b.

Revision of a currently approved collection

b.

Emergency - Approval requested by: ____/____/____

c.
d.

Extension of a currently approved collection
Reinstatement, without change, of a previously approved

c.

Delegated

5. Small entities

collection for which approval has expired
e. ✔ Reinstatement, with change, of a previously approved
collection for which approval has expired

Will this information collection have a significant economic impact on a
substantial number of small entities?
Yes

Existing collection in use without an OMB control number

f.

No

✔

6. Requested expiration date

For b-f, note Item A2 of Supporting Statement instructions

a.

✔

Three years from the approval date

b.

_____/_____

7. Title Voluntary Appeal File (VAF) Brochure
8. Agency form number(s) (if applicable)

N/A
9. Keywords

National Instant Criminal Background Check System Voluntary Appeal File
10. Abstract

The Voluntary Appeal File was established to prevent extended delays and erroneous denials pursuant to 28 Code of Federal Regulation, Part 25.9(b)(1),
(2), and (3)
11. Affected public (Mark primary with "P" and all others with "X")

12. Obligation to respond (Mark primary with "P" and all others that apply with "X")
a. P Voluntary
Required to obtain or retain benefits
b.

P Individuals or households
a. __

d. __ Farms

b. __ Business or other for-profit

e. __ Federal Government

c. __ Not-for-profit institutions

f. __ State, Local, or Tribal Government

13. Annual reporting and recordkeeping hour burden
a. Number of respondents

Mandatory
c.
14. Annual reporting and recordkeeping cost burden(in thousands of dollars)

b. Total annual responses

b. Total annual costs (O&M)

1. Percentage of these responses

c. Total annualized cost requested

0

collected electronically
c. Total annual hours requested

%

d. Current OMB inventory
e. Difference

2,000
2,000
0

d. Current OMB inventory
e. Difference

N/A
$80,000
N/A
N/A
N/A

a. Total annualized capital/startup costs

4,000
4,000

f. Explanation of difference

N/A
N/A

1. Program change

f. Explanation of difference

2. Adjustment

1. Program change

0
2. Adjustment
15. Purpose of information collection (Mark primary with "P" and all others
that apply with "X")

16. Frequency of recordkeeping or reporting(check all that apply)
a.

a. __ Application for benefits

e. X
__ Program planning or management c.

b. __ Program evaluation

f. __ Research

c. __ General purpose statistics g. P
__ Regulatory or compliance
d. __ Audit

Recordkeeping

b. ✔ Third party disclosure

Reporting:
1.

On occasion

2.

Weekly

4.
7.

Quarterly
Biennially

5.
8.

Semi-annually 6.
Annually
Other (describe) ____________

3.

✔Monthly

18. Agency contact (person who can best answer questions regarding the content

17. Statistical methods
Does this information collection employ statistical methods?
Yes

No ✔

of this submission)

Gerry Lynn Brovey, Supervisory Information
Name: ______________________________________________________
(304) 625-4320
Phone: ______________________________________________________

OMB 83-I

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19. Certification for Paperwork Reduction Act Submissions
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with
5 CFR 1320.9.
NOTE: The text of 5 CFR 1320.9, and the related provisions of 5 CFR 1320.8(b)(3), appear at the end of the
instructions. The certification is to be made with reference to those regulatory provisions as set forth in
the instructions.
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) If 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 (see note in Item 19 of the instructions);
(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 below and explain the reason in
Item 18 of the Supporting Statement.

Signature of Senior Official or designee

OMB 83-I

Date

10/95

f.2. "Adjustment" is a change that is not the result of a
deliberate Federal government action. Changes
resulting from new estimations or actions not
controllable by the Federal government are recorded
as adjustments.
15. Purpose of information collection
Mark all categories that apply, denoting the primary
purpose with a "P" and all others that apply with "X."
a. Mark "Application for benefits" when the purpose is
to participate in, receive, or qualify for a grant, financial
assistance, etc., from a Federal agency or program.
b. Mark "Program evaluation" when the purpose is a
formal assessment, through objective measures and
systematic analysis, of the manner and extent to which
Federal programs achieve their objectives or produce
other significant effects.
c. Mark "General purpose statistics" when the data is
collected chiefly for use by the public or for general
government use without primary reference to the policy
or program operations of the agency collecting the
data.
d. Mark "Audit" when the purpose is to verify the
accuracy of accounts and records.
e. Mark "Program planning or management" when the
purpose relates to progress reporting, financial
reporting and grants management, procurement and
quality control, or other administrative information that
does not fit into any other category.

f. Mark "Research" when the purpose is to further the
course of research, rather than for a specific program
purpose.
g. Mark "Regulatory or compliance" when the
purpose is to measure compliance with laws or
regulations.
16. Frequency of recordkeeping or reporting
Check "Recordkeeping" if the collection of information
explicitly includes a recordkeeping requirement.
Check "Third party disclosure" if a collection of
information includes third-party disclosure
requirements as defined by 1320.3(c).

18. Agency contact

Provide the name and telephone number of the agency

person best able to answer questions regarding the

content of this submission.

19. Certification for Paperwork Reduction Act
Submissions
The Senior Official or designee signing this statement
certifies that the collection of information encompassed
by the request complies with 5 CFR 1320.9. Provisions
of this certification that the agency cannot comply with
should be identified here and fully explained in item 18 of
the attached Supporting Statement. NOTE: The Office
that "develops" and "uses" the information to be collected
is the office that "conducts or sponsors" the collection of
information. (See 5 CFR 1320.3(d)).

Check "Reporting" for information collections that
involve reporting and check the frequency of reporting
that is requested or required of a respondent. If the
reporting is on "an event" basis, check "On occasion."
17. Statistical methods
Check "Yes" if the information collection uses
statistical methods such as sampling or imputation.
Generally, check "No" for applications and audits
(unless a random auditing scheme is used). Check
"Yes" for statistical collections, most research
collections, and program evaluations using scientific
methods. For other types of data collection, the use
of sampling, imputation, or other statistical estimation
techniques should dictate the response for this item.
Ensure that supporting documentation is provided in
accordance with Section B of the Supporting
Statement.

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Certification Requirement for Paperwork Reduction Act Submissions
5 CFR 1320.9 reads "As part of the agency submission to OMB of a proposed collection of information, the agency (through
the head of the agency, the Senior Official, or their designee) shall certify (and provide a record supporting such certification)
that the proposed collection of information-­
"(a) is necessary for the proper performance of the functions of the agency, including that the information to be collected
will have practical utility;
"(b) is not unnecessarily duplicative of information otherwise reasonably accessible to the agency;
"(c) reduces to the extent practicable and appropriate the burden on persons who shall provide information to or for the
agency, including with respect to small entities, as defined in the Regulatory Flexibility Act (5 U.S.C. § 601(6)), the use of such
techniques as:
"(1) establishing differing compliance or reporting requirements or timetables that take into account the resources
available to those who are to respond;
"(2) the clarification, consolidation, or simplification of compliance and reporting requirements; or collections of infor­
mation, or any part thereof;
"(3) an exemption from coverage of the collection of information, or any part thereof;
"(d) is written using plain, coherent, and unambiguous terminology and is understandable to those who are to respond;
"(e) is to be implemented in ways consistent and compatible, to the maximum extent practicable, with the existing reporting
and recordkeeping practices of those who are to respond;
"(f) indicates for each recordkeeping requirement the length of time persons are required to maintain the records specified;
"(g) informs potential respondents of the information called for under §1320.8(b)(3); [see below]
"(h) has been developed by an office that has planned and allocated resources for the efficient and effective management and
use of the information to be collected, including the processing of the information in a manner which shall enhance, where
appropriate, the utility of the information to agencies and the public;
"(i) uses effective and efficient statistical survey methodology appropriate to the purpose for which the information is to be
collected; and
"(j) to the maximum extent practicable, uses appropriate information technology to reduce burden and improve data quality,
agency efficiency and responsiveness to the public."
NOTE: 5 CFR 1320.8(b)(3) requires that each collection of information:
"(3) informs and provides reasonable notice to the potential persons to whom the collection of information is addressed of:
"(i) the reasons the information is planned to be and/or has been collected;
"(ii) the way such information is planned to be and/or has been used to further the proper performance of the functions
of the agency;
"(iii) an estimate, to the extent practicable, of the average burden of the collection (together with a request that the
public direct to the agency any comments concerning the accuracy of this burden estimate and any suggestions for reducing
this burden);
"(iv) whether responses to the collection of information are voluntary, require to obtain or retain a benefit (citing
authority) or mandatory (citing authority);
"(v) the nature and extent of confidentiality to be provided, if any (citing authority); and
"(vi) the fact that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number."

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Supporting Statement for Paperwork Reduction Act Submissions
General Instructions
A Supporting Statement, including the text of the notice to
the public required by 5 CFR 1320.5(a)(i)(iv) and its actual
or estimated date of publication in the Federal Register,
must accompany each request for approval of a collection of
information. The Supporting Statement must be prepared in
the format described below, and must contain the
information specified in Section A below. If an item is not
applicable, provide a brief explanation. When Item 17 of the
OMB Form 83-I is checked "Yes", Section B of the
Supporting Statement must be completed. OMB reserves
the right to require the submission of additional information
with respect to any request for approval.

Specific Instructions
A. Justification
1. Explain the circumstances that make the collection of
information necessary. Identify any legal or administrative
requirements that necessitate the collection. Attach a copy
of the appropriate section of each statute and regulation
mandating or authorizing the collection of information.
2. Indicate how, by whom, and for what purpose the
information is to be used. Except for a new collection,
indicate the actual use the agency has made of the
information received from the current collection.
3. Describe whether, and to what extent, the collection of
information involves the use of automated, electronic,
mechanical, or other technological collection techniques or
other forms of information technology, e.g., permitting
electronic submission of responses, and the basis for the
decision for adopting this means of collection. Also describe
any consideration of using information technology to reduce
burden.
4. Describe efforts to identify duplication. Show specifically
why any similar information already available cannot be
used or modified for use for the purposes described in Item
2 above.
5. If the collection of information impacts small businesses
or other small entities (Item 5 of OMB Form 83-I), describe
any methods used to minimize burden.
6. Describe the consequence to Federal program or policy
activities if the collection is not conducted or is conducted
less frequently, as well as any technical or legal obstacles
to reducing burden.
7. Explain any special circumstances that would cause an
information collection to be conducted in a manner:
* requiring respondents to report information to the agency
more often than quarterly;
* requiring respondents to prepare a written response to a
collection of information in fewer than 30 days after receipt
of it;
* requiring respondents to submit more than an original and
two copies of any document;

* requiring respondents to retain records, other than
health, medical, government contract, grant-in-aid, or
tax records, for more than three years;
* in connection with a statistical survey, that is not
designed to produce valid and reliable results that can
be generalized to the universe of study;
* requiring the use of a statistical data classification that
has not been reviewed and approved by OMB;
* that includes a pledge of confidentiality that is not
supported by authority established in statute or
regulation, that is not supported by disclosure and data
security policies that are consistent with the pledge, or
which unnecessarily impedes sharing of data with other
agencies for compatible confidential use; or
* requiring respondents to submit proprietary trade
secrets, or other confidential information unless the
agency can demonstrate that it has instituted
procedures to protect the information's confidentiality to
the extent permitted by law.
8. If applicable, provide a copy and identify the date
and page number of publication in the Federal Register
of the agency's notice, required by 5 CFR 1320.8(d),
soliciting comments on the information collection prior
to submission to OMB. Summarize public comments
received in response to that notice and describe actions
taken by the agency in response to these comments.
Specifically address comments received on cost and
hour burden.
Describe efforts to consult with persons outside the
agency to obtain their views on the availability of data,
frequency of collection, the clarity of instructions and
recordkeeping, disclosure, or reporting format (if any),
and on the data elements to be recorded, disclosed, or
reported.
Consultation with representatives of those from whom
information is to be obtained or those who must
compile records should occur at least once every 3
years - even if the collection of information activity is
the same as in prior periods. There may be
circumstances that may preclude consultation in a
specific situation. These circumstances should be
explained.
9. Explain any decision to provide any payment or gift
to respondents, other than reenumeration of
contractors or grantees.
10. Describe any assurance of confidentiality provided
to respondents and the basis for the assurance in
statute, regulation, or agency policy.
11. Provide additional justification for any questions of a
sensitive nature, such as sexual behavior and attitudes,
religious beliefs, and other matters that are commonly
considered private. This justification should include the
reasons why the agency considers the questions
necessary, the specific uses to be made of the
information, the explanation to be given to persons from
whom the information

is requested, and any steps to be taken to obtain
their consent.
12. Provide estimates of the hour burden of the
collection of information. The statement should:
* Indicate the number of respondents, frequency of
response, annual hour burden, and an explanation of
how the burden was estimated. Unless directed to
do so, agencies should not conduct special surveys
to obtain information on which to base hour burden
estimates. Consultation with a sample (fewer than
10) of potential respondents is desirable. If the hour
burden on respondents is expected to vary widely
because of differences in activity, size, or
complexity, show the range of estimated hour
burden, and explain the reasons for the variance.
Generally, estimates should not include burden
hours for customary and usual business practices.
* If this request for approval covers more than one
form, provide separate hour burden estimates for
each form and aggregate the hour burdens in Item
13 of OMB Form 83-I.
* Provide estimates of annualized cost to
respondents for the hour burdens for collections of
information, identifying and using appropriate wage
rate categories. The cost of contracting out or paying
outside parties for information collection activities
should not be included here. Instead, this cost
should be included in Item 13.
13. Provide an estimate for the total annual cost
burden to respondents or recordkeepers resulting
from the collection of information. (Do not include
the cost of any hour burden shown in Items 12 and
14).
* The cost estimate should be split into two
components: (a) a total capital and start-up cost
component (annualized over its expected useful life)
and (b) a total operation and maintenance and
purchase of services component. The estimates
should take into account costs associated with
generating, maintaining, and disclosing or providing
the information. Include descriptions of methods
used to estimate major cost factors including system
and technology acquisition, expected useful life of
capital equipment, the discount rate(s), and the time
period over which costs will be incurred. Capital and
start-up costs include, among other items,
preparations for collecting information such as
purchasing computers and software; monitoring,
sampling, drilling and testing equipment; and record
storage facilities.
* If cost estimates are expected to vary widely,
agencies should present ranges of cost burdens and
explain the reasons for the variance. The cost of
purchasing or contracting out information collections
services should be a part of this cost burden
estimate. In developing cost burden estimates,
agencies may consult with a sample of respondents
(fewer than 10), utilize the 60-day pre-OMB
submission public comment process and use

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existing economic or regulatory impact analysis
associated with the rulemaking containing the
information collection, as appropriate.
* Generally, estimates should not include
purchases of equipment or services, or portions
thereof, made: (1) prior to October 1, 1995, (2) to
achieve regulatory compliance with requirements
not associated with the information collection, (3)
for reasons other than to provide information or
keep records for the government, or (4) as part of
customary and usual business or private
practices.
14. Provide estimates of annualized costs to the
Federal government. Also, provide a description of
the method used to estimate cost, which should
include quantification of hours, operational
expenses (such as equipment, overhead, printing,
and support staff), and any other expense that
would not have been incurred without this
collection of information. Agencies may also
aggregate cost estimates from Items 12, 13, and
14 in a single table.
15. Explain the reasons for any program changes
or adjustments reported in Items 13 or 14 of the
OMB Form 83-I.
16. For collections of information whose results
will be published, outline plans for tabulation and
publication. Address any complex analytical
techniques that will be used. Provide the time
schedule for the entire project, including beginning
and ending dates of the collection of information,
completion of report, publication dates, and other
actions.

17. If seeking approval to not display the expiration
date for OMB approval of the information collection,
explain the reasons that display would be
inappropriate.
18. Explain each exception to the certification
statement identified in Item 19, "Certification for
Paperwork Reduction Act Submissions," of OMB Form
83-I.
B. Collections of Information Employing
Statistical Methods
The agency should be prepared to justify its decision not to
use statistical methods in any case where such methods
might reduce burden or improve accuracy of results. When
Item 17 on the Form OMB 83-I is checked, "Yes," the
following documentation should be included in the
Supporting Statement to the extend that it applies to the
methods proposed:

1. Describe (including a numerical estimate) the
potential respondent universe and any sampling or
other respondent selection methods to be used. Data
on the number of entities (e.g., establishments, State
and local government units, households, or persons)
in the universe covered by the collection and in the
corresponding sample are to be provided in tabular
form for the universe as a whole and for each of the
strata in the proposed sample. Indicate expected
response rates for the collection as a whole. If the
collection had been conducted previously, include the
actual response rate achieved during the last
collection.

2. Describe the procedures for the collection of information
including:
* Statistical methodology for stratification and sample
selection,
* Estimation procedure,
* Degree of accuracy needed for the purpose described in
the justification,
* Unusual problems requiring specialized sampling
procedures, and
* Any use of periodic (less frequent than annual) data
collection cycles to reduce burden.
3. Describe methods to maximize response rates and to
deal with issues of non-response. The accuracy and
reliability of information collected must be shown to be
adequate for intended uses. For collections based on
sampling, a special justification must be provided for any
collection that will not yield "reliable" data that can be
generalized to the universe studied.
4. Describe any tests of procedures or methods to be
undertaken. Testing is encouraged as an effective means
of refining collections of information to minimize burden and
improve utility. Tests must be approved if they call for
answers to identical questions from 10 or more
respondents. A proposed test or set of test may be
submitted for approval separately or in combination with the
main collection of information.
5. Provide the name and telephone number of individuals
consulted on statistical aspects of the design and the name
of the agency unit, contractor(s), grantee(s), or other
person(s) who will actually collect and/or analyze the
information for the agency.

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PAPERWORK REDUCTION ACT SUBMISSION

Please read the instructions before completing this form. For additional forms or assistance in completing this form, contact your agency's Paperwork
Clearance Officer. Send two copies of this form, the collection instrument to be reviewed, the Supporting Statement, and any additional documentation
to: Office of Information and Regulatory Affairs, Office of Management and Budget, Docket Library, Room 10102, 725 17th Street NW,
Washington, DC 20503.
1. Agency/Subagency originating request

a. __ __ __ __ __ - __ __ __ __

FBI/CJIS
3. Type of information collection (check one)

__ __ __ __

4. Type of review requested (check one)

a. ✔ New Collection

Regular
a.
10 16 18
b. ✔ Emergency - Approval requested by: ____/____/____

b.

Revision of a currently approved collection

c.
d.

Extension of a currently approved collection
Reinstatement, without change, of a previously approved

e.

collection for which approval has expired
Reinstatement, with change, of a previously approved

Delegated

c.

5. Small entities
Will this information collection have a significant economic impact on a
substantial number of small entities?

collection for which approval has expired

Yes

Existing collection in use without an OMB control number

f.

b. ✔ None

2. OMB control number

No

✔

6. Requested expiration date

For b-f, note Item A2 of Supporting Statement instructions

Three years from the approval date

a.

b. ✔

12 2019
_____/_____

7. Title

FIX NICS Act State Implementation Plan Survey
8. Agency form number(s) (if applicable)
9. Keywords

Fix NICS Act, State Implentation Plan Survey
10. Abstract
In March 2018, Congress passed the Fix NICS Act, Pub. L. 115-141, tit. VI, which aims to improve the National Instant Criminal Background Check System (NICS), to include requiring the Attorney General, in coordination with each State, to establish an implementation plan. The plan is intended to “ensure
maximum coordination and automation of the reporting or making available appropriate records to the [NICS]… and the verification of the accuracy of those records during a 4-year period specified in the plan.” In addition, the Act requires that each plan establish annual benchmarks to enable the Attorney General
to assess the implementation of each plan. These benchmarks include qualitative goals, quantitative measures, and a needs assessment with estimated compliance costs. This request is to collect information to aid in the identification and development of these key areas, and to satisfy the requirements of the
implementation plan.

11. Affected public (Mark primary with "P" and all others with "X")

12. Obligation to respond (Mark primary with "P" and all others that apply with "X")
a. P Voluntary

a. __ Individuals or households

d. __ Farms

b. __ Business or other for-profit

e. __ Federal Government

c. __ Not-for-profit institutions

f. P
__ State, Local, or Tribal Government

b. ✔ Required to obtain or retain benefits

13. Annual reporting and recordkeeping hour burden
a. Number of respondents
b. Total annual responses

Mandatory
c.
14. Annual reporting and recordkeeping cost burden(in thousands of dollars)
a. Total annualized capital/startup costs

56
56

b. Total annual costs (O&M)

1. Percentage of these responses

100
c. Total annual hours requested 40
N/A
d. Current OMB inventory
0
e. Difference
collected electronically

c. Total annualized cost requested
%

d. Current OMB inventory
e. Difference
f. Explanation of difference
1. Program change

f. Explanation of difference
1. Program change

0
0
0
N/A
NA

2. Adjustment

N/A
N/A

Yes
N/A

2. Adjustment
15. Purpose of information collection (Mark primary with "P" and all others
that apply with "X")

16. Frequency of recordkeeping or reporting(check all that apply)
a.

Recordkeeping

a. __ Application for benefits

e. __ Program planning or management c. ✔ Reporting:

b. __ Program evaluation

f. __ Research

c. __ General purpose statistics g. P
__ Regulatory or compliance
d. __ Audit
17. Statistical methods
Does this information collection employ statistical methods?
No ✔
Yes

b.

Third party disclosure
Weekly

1.

On occasion

2.

4.
7.

Quarterly
Biennially

Semi-annually 6.
Annually
5.
1X collection
8. ✔ Other (describe) ____________

3.

Monthly

18. Agency contact (person who can best answer questions regarding the content
of this submission)
Gerry Lynn Brovey, Supervisory Information Liaison Specialist
Name: ______________________________________________________

(304) 625-4320
Phone: ______________________________________________________
OMB 83-I

10/95