Information Collection

Defined Monetary Assistance Victims Reserve Claim Form

IC 269909 under ICR 202405-1103-001 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Defined Monetary Assistance Victims Reserve Claim Form	Form and Instruction
1 Defined Monetary Assistance Victims Reserve Claim Form 2024-05-01 DMAVR Paper Claim Final.pdf	Form and Instruction
1 Defined Monetary Assistance Victims Reserve Claim Form 2024-05-01 DMAVR Paper Claim Final.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

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 and Instruction	1	Defined Monetary Assistance Victims Reserve Claim Form	2024-05-01 DMAVR Paper Claim Final.pdf		Yes	Yes	Fillable Fileable

Line of Business: Law Enforcement

Subfunction: Crime Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

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	150	150
Annual IC Time Burden (Hours)	300	300
Annual IC Cost Burden (Dollars)	0	0

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.