Information Collection

Congressional Badge of Bravery

IC 209119 under ICR 202005-1121-003 · OMB 1121-0330.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0330 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Congressional Badge of Bravery	Form
Congressional Badge of Bravery application cbob-application.jpg	Form
completion page complete.jpg	Form
event form page event-form.jpg	Form
nominator form page nominator-form.jpg	Form
nominee form page nominee-form.jpg	Form
supporting form page supporting-form.jpg	Form
thanks page thanks.jpg	Form
witness page witness-form.jpg	Form

IC Title:

Congressional Badge of Bravery

Agency IC Tracking Number:

BJA

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	witness page	witness-form.jpg	Yes	Yes	Fillable Fileable
Form	none	Congressional Badge of Bravery application	cbob-application.jpg	Yes	Yes	Fillable Fileable
Form	none	completion page	complete.jpg	Yes	Yes	Fillable Fileable
Form	none	event form page	event-form.jpg	Yes	Yes	Fillable Fileable
Form	none	nominator form page	nominator-form.jpg	Yes	Yes	Fillable Fileable
Form	none	nominee form page	nominee-form.jpg	Yes	Yes	Fillable Fileable
Form	none	supporting form page	supporting-form.jpg	Yes	Yes	Fillable Fileable
Form	none	thanks page	thanks.jpg	Yes	Yes	Fillable Fileable

Line of Business: Law Enforcement

Subfunction: Leadership Protection

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 164

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	164	164
Annual IC Time Burden (Hours)	55	55
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.