COPS Extension Request Form

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
COPS Extension Request Form	Form and Instruction	Unchanged	Repair queued
COPS Extension Form	Form and Instruction	Unchanged	Repair queued
COPS Extension Form Request - Supporting Statement A.doc	Supporting Statement A	Uploaded 2015-08-20	Repair queued
Violent Crime Act of 1994.pdf	Supplementary Document	Uploaded 2009-05-18	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
203543	COPS Extension Form	Form and Instruction	Unchanged	COPS Extension Request Form
203543	COPS Extension Form	Form and Instruction	Unchanged

ICR Details

OMB Control No: 1103-0093	ICR Reference No: 202202-1103-001
Status: Historical Active	Previous ICR Reference No: 201811-1103-001
Agency/Subagency: DOJ/DOJADM	Agency Tracking No:
Title: COPS Extension Request Form
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: 04/05/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/01/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2025	36 Months From Approved	04/30/2022
Responses	1,500	0	1,500
Time Burden (Hours)	750	0	750
Cost Burden (Dollars)	750	0	750

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Abstract: The COPS Extension Request Form will be used in conjunction with all COPS Office grant programs. The four-page form allows grantees to request an extension of time for a particular grant by providing the status of its hiring/project activities, describing the reason the project cannot be implemented or completed on time, and providing current financial information. This information is used to determine whether the grantee has made adequate progress in hiring additional law enforcement officers, implementing their project and has sufficient funds available for the requested extension period. The form provides a summary of critical grant information: the particular program applied for, the number of officers awarded (if applicable), the award amount, remaining balance, and the start date of the grant. It is also required to indicate the title, name and email address of the requestor on page one of the forms. This information is requested to ensure that the database for the Office of Community Oriented Policing Services (COPS) contains the most current information on the grantee.

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Authorizing Statute(s): PL: Pub.L. 103 - 322 10003 Name of Law: Violent Crime and Control Act of 1994
  

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:
	86 FR 53680	09/28/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 69296	12/07/2021
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
COPS Extension Form	N/A	COPS Extension Request Form

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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	1,500	1,500	0	0	0	0
Annual Time Burden (Hours)	750	750	0	0	0	0
Annual Cost Burden (Dollars)	750	750	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: $15,000

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? Yes

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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: 02/01/2022

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