Information Collection

State Corrections Incident Report for Prison Input

IC 233651 under ICR 202108-1121-004 · OMB 1121-0365.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0365 can be found here:

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	Requested	Change Due to Potential Violation of the PRA
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

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.