State Corrections Incident Report for Prison Input

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⚠️ Notice: This information collection may be referencing outdated material.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 Corrections Incident Report for Prison Input Form
State Corrections Incident Report for Prison Input DCR-1A Death Report.pdf Form

Information Collection (IC) Details

IC Title:	State Corrections Incident Report for Prison Input	Agency IC Tracking Number:	BJA

Is this a Common Form? No		IC Status: Unchanged

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 Corrections Incident Report for Prison Input	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: 50	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,483	3,483
Annual IC Time Burden (Hours)	2,612	2,612
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.