Address Verification / Change Request Identity History Summary Check

Forms and Documents

Document	Type	Status	Availability
Form 1-797 Address Verification / Change Request Identity History Summary Check	Form and Instruction	Modified	Repair queued
Final Signed 1110-0072.pdf	Supplementary Document	Uploaded 2021-01-08	Repair queued
83-I 1-797.pdf	Supplementary Document	Uploaded 2021-01-08	Repair queued
1-797_Supporting Statement.docx	Supporting Statement A	Uploaded 2021-01-08	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
226044	Address Verification / Change Request Identity History Summary Check	Form and Instruction	Modified

ICR Details

OMB Control No: 1110-0072	ICR Reference No: 202011-1110-005
Status: Received in OIRA	Previous ICR Reference No: 201703-1110-001
Agency/Subagency: DOJ/FBI	Agency Tracking No:
Title: Address Verification / Change Request Identity History Summary Check
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 01/25/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved	01/31/2021
Responses	780	720
Time Burden (Hours)	26	24
Cost Burden (Dollars)	0	0

---

Abstract: DOJ's CJIS is requesting a PRA approval for an extension of a currently approved collection. The 1-797 provides the requester with ability to notify the FBI of any address changes.

---

Authorizing Statute(s): None

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 68091	10/27/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 3201	01/14/2021
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Address Verification / Change Request Identity History Summary Check	1-797	Address Verification/Change Form

---

ICR Summary of Burden

	Total Request	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	780	720	0	60	0	0
Annual Time Burden (Hours)	26	24	0	2	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: This is a new form necessary for the customers to correct or verify the address submitted with their Departmental Order 556-73 request.

---

Annual Cost to Federal Government: $15,186

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.     Yes

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? No

---

Common Form ICR:  No

---

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: 01/25/2021

---