Information Collection

National Elder Justice Prosecutor Survey

IC 277273 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⚠️ Notice: This information collection may be referencing outdated material.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 National Elder Abuse Survey National Elder Justice Prosecutor Survey	Form and Instruction
1103-0120 National Elder Abuse Survey MDT Needs Survey Instrument v3 10.24.24 submitted to PRA_OMB comments slj2 TR COMMENTS 6 3 25.docx	Form and Instruction
MDT Survey 10.24.24 ICR Template_A11 Section 280 Clearance v 5 13 24 2.18.25.docx Statement A	IC Document

IC Title:

National Elder Justice Prosecutor Survey

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

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: Crime Prevention

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	42	42
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Statement A		08/27/2025

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

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