Information Collection

Law Enforcement Officers Safety Act (LEOSA) Credential Program Application

IC 227796 under ICR 202401-0703-002 · OMB 0703-0067.

Documents and Forms

Document Name Document Type
0703-0067_NAVY Screenshots of LEOSA Application Process.docx Other-Screenshots
0703-0067_NAVY Screenshots of LEOSA Application Process.docx Other-Screenshots
0703_0067_NAVY LEOSA PAS and ADN_11.25.2020.pdf Other-Screenshots
0703_0067_NAVY LEOSA PAS and ADN_11.25.2020.pdf Other-Screenshots
0703-0067_USMC LEOSA PAS and ADN_11.25.2020.pdf Other-Screenshots
0703-0067_USMC LEOSA PAS and ADN_11.25.2020.pdf Other-Screenshots
0703_0067_USMC LEOSA Website application process Collection Instrument.11.23.2020.pdf Other-Screenshots
0703_0067_USMC LEOSA Website application process Collection Instrument.11.23.2020.pdf Other-Screenshots
Navy LEOSA Eligibility Questionnaire.pdf Other-Web Form
Navy LEOSA Eligibility Questionnaire.pdf Other-Web Form
JNAVMAR 5580/1 LAW ENFORCEMENT OFFICERS SAFETY ACT (LEOSA) CREDENTIAL A JNAVMAR 5580 1 (MAY 2022).pdf forms.documentservices.dla.mil/order/ Form
JNAVMAR 5580/1 LAW ENFORCEMENT OFFICERS SAFETY ACT (LEOSA) CREDENTIAL A JNAVMAR 5580 1 (MAY 2022).pdf forms.documentservices.dla.mil/order/ Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Law Enforcement Officers Safety Act (LEOSA) Credential Program Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screenshots			0703-0067_NAVY Screenshots of LEOSA Application Process.docx		Yes	Yes	Fillable Fileable
Other-Screenshots			0703_0067_NAVY LEOSA PAS and ADN_11.25.2020.pdf		Yes	Yes	Fillable Fileable
Other-Screenshots			0703-0067_USMC LEOSA PAS and ADN_11.25.2020.pdf		Yes	Yes	Fillable Fileable
Other-Screenshots			0703_0067_USMC LEOSA Website application process Collection Instrument.11.23.2020.pdf		Yes	Yes	Fillable Fileable
Form	JNAVMAR 5580/1	LAW ENFORCEMENT OFFICERS SAFETY ACT (LEOSA) CREDENTIAL APPLICATION	JNAVMAR 5580 1 (MAY 2022).pdf	https://forms.documentservices.dla.mil/order/	Yes	Yes	Fillable Fileable Signable
Other-Web Form			Navy LEOSA Eligibility Questionnaire.pdf		Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 250	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	250	0	250
Annual IC Time Burden (Hours)	500	0	500
Annual IC Cost Burden (Dollars)	19,680	6,080	13,600

Documents for IC

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.