Information Collection

Crime Victims' Rights Act Complaint Form

IC 261028 under ICR 202307-1105-001 · OMB 1105-0112.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Crime Victims' Rights Act Complaint Form	Form
CVRA Complaint Form Collection Instrument - English (CVRA Complaint Form) (002).pdf www.justice.gov/usao/office-victims-rights-ombuds	Form
CVRA Complaint Form Collection Instrument - English (CVRA Complaint Form) (002).pdf www.justice.gov/usao/office-victims-rights-ombuds	Form
CVRA Complaint Form Collection Instrument - Spanish (CVRA Complaint Form).pdf www.justice.gov/usao/office-victims-rights-ombuds	Form
CVRA Complaint Form Collection Instrument - Spanish (CVRA Complaint Form).pdf www.justice.gov/usao/office-victims-rights-ombuds	Form
Screenshot of Collection Instrument Website.pdf Web-portal screenshot	IC Document
Screenshot of Collection Instrument Website.pdf Web-portal screenshot	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	CVRA Complaint Form	Collection Instrument - English (CVRA Complaint Form) (002).pdf	https://www.justice.gov/usao/office-victims-rights-ombuds	Yes	Yes	Fillable Fileable
Form	None	CVRA Complaint Form	Collection Instrument - Spanish (CVRA Complaint Form).pdf	https://www.justice.gov/usao/office-victims-rights-ombuds	Yes	Yes	Fillable Fileable

Line of Business: Law Enforcement

Subfunction: Citizen Protection

Privacy Act System of Records

Title: Civil Case Files

FR Citation: 82 FR 24147

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Web-portal screenshot	Screenshot of Collection Instrument Website.pdf	07/11/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.