Form USM-523A, Sequestered Juror Information Form

Forms and Documents

Document	Type	Status	Availability
Form USM-523A Sequestered Juror Information Form	Form and Instruction	Modified	Available
Explanation of changes to USM-523A in 2022.docx	Supplementary Document	Uploaded 2022-02-16	Available
1105-0096-Supporting-Statement-2026-Renewal.docx	Supporting Statement A	Uploaded 2026-01-12	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
203434	Sequestered Juror Information Form	Form and Instruction	Modified	Sequestered Juror Information Form
203434	Sequestered Juror Information Form	Form and Instruction	Modified

ICR Details

OMB Control No: 1105-0096	ICR Reference No: 202504-1105-002
Status: Received in OIRA	Previous ICR Reference No: 202112-1105-001
Agency/Subagency: DOJ/LA	Agency Tracking No: 1105-0096
Title: Form USM-523A, Sequestered Juror Information Form
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 02/25/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	14	0
Time Burden (Hours)	1	0
Cost Burden (Dollars)	0	0

---

Abstract: The United States Marshals Service is responsible for ensuring the security of federal courthouses, courtrooms, and federal jurist. The information collected in this form assists Marshals Service personnel in the planning of, and response to, potential security needs of the court and jurors during the course of proceedings.

---

Authorizing Statute(s): US Code: 28 USC 561 Name of Law: United States Marshals Service
   US Code: 28 USC 509 Name of Law: Functions of the Attorney General
   US Code: 28 USC 510 Name of Law: Delegation of authority
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 22515	05/28/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 46259	09/25/2025
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Sequestered Juror Information Form	USM-523A	Sequestered Juror Information Form

---

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	14	0	0	0	0	14
Annual Time Burden (Hours)	1	0	0	0	0	1
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

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 language that is understandable to respondents;

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

(f) It indicates the retention periods for recordkeeping requirements;

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

(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.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/25/2026

---