Information Collection

Law Enforcement Officers Safety Act (LEOSA) Credential Program Application

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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form JNAVMAR 5580/1 LAW ENFORCEMENT OFFICERS SAFETY ACT (LEOSA) CREDENTIAL APPLICATION Law Enforcement Officers Safety Act (LEOSA) Credential Program Application	Form
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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screenshots			Yes	Yes	Fillable Fileable
Other-Screenshots			Yes	Yes	Fillable Fileable
Other-Screenshots			Yes	Yes	Fillable Fileable
Other-Screenshots			Yes	Yes	Fillable Fileable
Form	JNAVMAR 5580/1	https://forms.documentservices.dla.mil/order/	Yes	Yes	Fillable Fileable Signable
Other-Web Form			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 %

table that charts list of burden
	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

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.

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