Certification of Qualifying State Relief from Disabilities Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form ATF F 3210.12 Certification of Qualifying State Relief From Disabilities Program	Form and Instruction	Modified	Available
PL 110-180 (NIAA).pdf	Supplementary Document	Uploaded 2019-05-30	Available
27 CFR 478.11 Meaning of terms 4.1.2018.pdf	Supplementary Document	Uploaded 2019-05-30	Available
Justification for OMB 1140-0094 (ATF F 3210.12) 5.21.2019.docx	Supporting Statement A	Uploaded 2019-05-30	Available
18 U.S.C. 922 Unlawful acts.pdf	Supplementary Document	Uploaded 2019-05-30	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
188936	Certification of Qualifying State Relief From Disabilities Program	Form and Instruction	Modified

ICR Details

OMB Control No: 1140-0094	ICR Reference No: 201905-1140-007
Status: Active	Previous ICR Reference No: 201603-1140-007
Agency/Subagency: DOJ/ATF	Agency Tracking No:
Title: Certification of Qualifying State Relief from Disabilities Program
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/01/2019
	Date Received in OIRA: 05/31/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2022	36 Months From Approved	07/31/2019
Responses	50	0	50
Time Burden (Hours)	13	0	13
Cost Burden (Dollars)	0	0	0

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Abstract: This form is used by a State to certify to the U.S. Department of Justice, Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) that it has established a qualifying mental health relief from firearms disabilities program, based on certain minimum criteria established by the NICS Improvement Amendment Act of 2007, Public Law 110-180, Section 105, enacted January 8, 2008 (NIAA). This certification is required for States to be eligible for certain grants authorized by the NIAA.

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Authorizing Statute(s): US Code: 18 USC 922 Name of Law: Unlawful Acts
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 11324	03/26/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 25070	05/30/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Certification of Qualifying State Relief From Disabilities Program	ATF F 3210.12	Certification of Qualifying State Relief from Disabilities Program

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	50	50	0	0	0	0
Annual Time Burden (Hours)	13	13	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

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) It 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.

(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 by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/31/2019

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