Information Collection

Elder Justice Abuse Survey

IC 275318 under ICR 202407-1103-001 · OMB 1103-0120.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1103-0120 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1103-0120 Prosecutor Survey Elder Justice Abuse Survey	Form and Instruction
1103-0120 Prosecutor Survey Prosecutor Survey Instrument 5.15.25.docx	Form and Instruction
EJI Prosecutor Survey ICR Template_A11 Section 280 Clearance 1ROCIS VERSION OMB COMMENTS 5 6 25 slj TR COMMENTS 5 9 25 (3).docx A-11 Section 280 Clearance	IC Document

IC Title:

Elder Justice Abuse Survey

Agency IC Tracking Number:

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	1103-0120				Yes	Yes	Fillable Fileable

Line of Business: Law Enforcement

Subfunction: Citizen Protection

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	1,000	1,000
Annual IC Time Burden (Hours)	250	250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
A-11 Section 280 Clearance		05/15/2025

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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