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 reviev.ed, the Supporting Statement, and any additional documentation
to: Office of Information and Regulatory Affairs, Office of Management and Budget, Docket Library, Room 10102, 72517th Street NW,
Washinaton, DC 20503.
1. Agency'Subagency

originating

2. OM S control

request

DOJIFBI
3. Type of information

collection

aC

New collection

be
c[7

ReviSion

de

Reinstatement,

of a currently

Extension,
which

approval

approval

.!:

change,

approved

of a previously

collection

----

approved

collection

b.

C. Emergency

(check

- Approval

one)

requested

by:

C Delegated

approved

collection

for which

Will this information
substantial

in use without

an OMS control

public comments
Yes

on this information

"

collection

number

--'--'--

have a significant

of small entities?

-

number

6. Requested

received

requested

E Regular

----

5. Small entities
of a previously

Comments

Has the agency

C None

for

has expired
with change,

collection

----

a.
c.

has expired

Existing

3a. Public

collection

of a currently

b.

_ 0082

4. Type of review

one)

approved

change,

without

Reinstatement,

eC
f.

without

(check

number

I I 10

a.

collection?

a.

expiration

E Three

economic

~ No

Yes

impact

on a

date

years from

approval

date

b.C

Other

Specify:

___

' ___

No

7. Title

Law Enforcement Suicide Data Collection
8. Agency

form num ber(s)

(if applicable)

None
9. Keywords

Suicide, Attempted

Suicide, Law Enforcement

Agency, Law Enforcement

Officer

10. Abstract

Under Title 34, United States Code, Section 50701, the Law Enforcement Suicide Data Collection Act, the
Law Enforcement Suicide Data Collection receives data on suicides and attempted suicides within the law
enforcement community,
11. Affected

public

(Mark

primary

with

"P" and all others

that apply

- Individuals or households
b._ Business or other fOf-profit

d.

c._

f..!... State, Local or Tribal

a

Not-for-profit

13. Annual

institutions

reporting

a. Number

and recordkeepinp

collected

d Current OMS
e. Difference
f. Explanation
1 Program

a. _Application
b. _Program
d.

- Audit

17. Statistical

Government

hnlJf hlm1p.n

requested

Required to obtain or retain benefits
Mandatory

b. Total

annual

c. Total

annualized

(Mark

(Jammry

capital/startup

costs

primary

with "P" and al/

e. _Program
planning
f. ....:..Research
g. _Regulatory

16. Frequency

or management

statistical
Yes

"X")

of dollars)

0

costs

(O&M)

lin thousands

with

0

cost requested

0
0
·0

of difference
0

change

-0

or compliance

methods?

- No

of record keeping

rdkeeping

or reporting

(check

b. _Third

all that apply)
party

disclosure

c. ~Reporting
4. _Quarterly

2. _Weekly
5. _Semi-annually

7. _Biennially

8. _Other

1. _On

18. Agency
employ

cost burden

that apply

2022 • November 2024)

a. _Reco

..:!.....

occasion

contact

(person

Malissa

C. Vavra

3. _Monthly
6. ~ Annuallv

(describe)

who can best answer

questions

regarding

the content

of this

submission)
Name:

Phone:

OMB 83-1

and recordkeeping

"po and all others

0 MB inventory

1. Program

methods
collection

reporting

f. Explanation

with "X")

Does this information

with

b.
c. _

2. Adjustment

collection

primary

e. Difference

Based on ,j!lla colleclN

statistics

(Mark

Voluntary

d Current
312.5

-137.5

purpose

to respond

a. ~

a. Total annualized

450

for benefits
evaluation

12. Obligation

14. Annual

100

inventory

of information

.!_ General

Government

of differen('p
change ____

that apply

c.

Federal

50

2. Adjustment

others

"X")

respnn.c:A.c:

electronically

c. Total annual hours

with

Farms

50

of respondents

b Total annual responses
1.Percentage
of these

15. Purpose

e. x.

(304) 625·3010

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.

Date

OMB 83-[

02/04