83i

PAPERWORK REDUCTION ACT SUBMISSION
Please read the instructions before completing this form. For additional forms or assistance in completing this form, contact your agency's Paperwork
Clearance Officer. Send two copies of this form, the collection instrument to be revie11Ved, the Supporting Statement , and any additional documentation
to: Office of Information and Regulatory Affairs, Office of Management and Budget, Docket Library, Room 1010 2, 725 17th Street NW,

Washington, DC 20503.

1. Agency/Subagency originating request

D01 I Federal Bureau oflnvestigation
3. Type of information collection (check one)
aC: New collection
bC Revision of a currently approved collection
C
Extension, without change, of a currently approved collection
d.
Reins tatement, without change, of a previously approved collection for
which approval has expired
eC
Reinstatement, with change, of a previously approved collection for which

!2:'

t..C

approval has expired

Existing collection in use without an 0MB control number

3a. Public Comments
Has the agency received public comments on this i nformation collection?
Yes

b. C.None

2. 0MB control number

---- ----

----

_ 0053

a. 1110

4. Type of review requested (check one)
a. �Regular
b. r, Em ergency - Approval req uested by:
c.
Delegated

C:

,__,__

__

5. Small entities
Will this information collection have a significant economic impact on a
substantial number of small entities?
Yes
No

-

-

6. Requested expiration date
a. @ Three year s from approval date b.r:::Jother Specify: ___/___

✓ No

7. Title

FBI eFOIA
8. Agen cy form num ber(s) (if applicable)
Electronic FOIPA Request
9. Keywords

10. Abstract

This voluntary form allows requesters to make a FOIA request via electronic submission
11. Affected public (Mark primary with "P" and all others that apply with "X")

a.� Individuals or households

b.� Business or other for-profit
c.!.... Not-for-profit institutions

Farms
d
Federal Government
e
f..!.,_ State, Local or Tribal Government

-·

12. Obligation to respond (Mark primary with "P" and all others that apply with "X")
a. i_ Voluntary
b. _ Required to obtain or retain benefits
c. _ Mandatory

13. Annual reporting and recordkeepinp hoi,r hLJrr1M
1,053
a. Number of respondents
1.053
b. Total annual responses
1.Percentage of these respnn�A�
collected electronically 100%
c. Total annual hours requested 137
d. Current O MB inventory
e. Difference
f. Explanation of differenr.A
1. Program change___ _
2. Adjustment

14. Annual reporting and recordkeeping cost burden /in thousands of dollars)
a. Total annualized capital/startup costs
$1,0000
b. Total annual costs (O&M)
C. Total annualized cost requested
d. Current 0MB inventory
e. Difference
f. Explanation of difference
1. Program change
2. Adjustment
.

15. Purpose of information collection
others that apply with "X")
a. 2:.,_Application for benefits
b. !_Program evaluation
c. ..:_General purpose statistics
d. !_Audit

16. Frequency of record keeping or reporting (check all that apply)
b. _Third party disclosure
a. _Recordkeeping
c. _Reporting
3. _Monthly
2. _Weekly
1. _On occasion
5. _Semi-annually 6. ✓ Ann uallv
4. _Quarterly
7. _Biennially
8. _Other (describe)

(Mark primary with •p• and all
e. �Program planning or management
f. .!_ Research
g. !.,_Regulatory or compliance

17. Statistical methods
Does this information collection employ statistical methods?

-Yes

.!.... No

18. Agency contact {p erson who can best answer questions regarding the content of this

submission)
Name:

Shannon Hammer

Phone: 540-868-2101

0MB 83-1

02/04

19. Certification

for Paperwork

Reduction Act Submissions

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR
1320.9.

Note:

The text of 5 CFR 1320.9, and the related provisions of 5 CFR 1320.8(b)(3), appear at the end of the instructions.
The certification is to be made with reference to those regulatory provisions as set forth in the instructions.

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a)

It is necessary for the proper performance of agency functions;

(b)

It avoids unnecessary duplication;

(c)

It reduces burden on small entities;

(d)

It uses plain, coherent, and unambiguous terminology that is understandable to respondents;

(e)

Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f)

It indicates the retention period for recordkeeping requirements;

(g)

It informs respondents of the information called for under 5 CFR 1320.8(b)(3):
(i)

Why the information is being collected;

(ii)

Use of information;

(iii)

Burden estimate;

(iv)

Nature of response (voluntary, required for a benefit, or mandatory);

(v)

Nature and extent of confidentiality; and

(vi)

Need to display currently valid OMB control number;

(h)

It was developed by an office that has planned and allocated resources for the efficient and effective
management and use of the information to be collected (see note in Item 19 of the instructions);

(i)

It uses effective and efficient statistical survey methodology; and

U)

It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item below and explain the reason in Item 18 of
the Supporting Statement.

SJL·gna
ure of Senior Official or designee
n~___
fl. ~V~~ A.A.'
A

OMB 83-1

~

~

Date
-

D/

1'2 / 2-01-

t.f

02/04