Information Collection Request

Law Enforcement Officers Safety Act (LEOSA) Credential Program

ICR 202401-0703-002 · OMB 0703-0067 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form JNAVMAR 5580/1 LAW ENFORCEMENT OFFICERS SAFETY ACT (LEOSA) CREDENTIAL APPLICATION Form Modified Available
Endorsement-Memo-9_Apr_18.pdf Supplementary Document Uploaded 2024-01-30 Repair queued
Updated LEOSA Universal Application v11.docx Supplementary Document Uploaded 2024-01-30 Repair queued
0703-0067_SSA_1.31.2024.docx Supporting Statement A Uploaded 2024-01-31 Repair queued
DRAFT_Privacy Impact Assessment.pdf Supplementary Document Uploaded 2020-11-30 Repair queued
0703_0067_SSN Justification Memo_11.20.2020.doc.pdf Supplementary Document Uploaded 2020-11-24 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
227796 Law Enforcement Officers Safety Act (LEOSA) Credential Program Application Form ModifiedLAW ENFORCEMENT OFFICERS SAFETY ACT (LEOSA) CREDENTIAL APPLICATION
227796 Law Enforcement Officers Safety Act (LEOSA) Credential Program Application Other-Screenshots Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2027 36 Months From Approved 03/31/2024
250 0 250
500 0 500
19,680 0 13,600





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Law Enforcement Officers Safety Act (LEOSA) Credential Program Application JNAVMAR 5580/1

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 250 250 0 0 0 0
Annual Time Burden (Hours) 500 500 0 0 0 0
Annual Cost Burden (Dollars) 19,680 13,600 0 0 6,080 0


Reginfo record details
  No