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View ICR - OIRA Conclusion
OMB Control No:
1121-0024
ICR Reference No:
200611-1121-004
Status:
Historical Inactive
Previous ICR Reference No:
200404-1121-001
Agency/Subagency:
DOJ/OJP
Agency Tracking No:
Title:
Claim for Death Benefits
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Withdrawn and continue
Conclusion Date:
07/30/2007
Retrieve Notice of Action (NOA)
Date Received in OIRA:
05/21/2007
Terms of Clearance:
Needs to be resubmitted for emergency extension for 6 months. Expiration is 7/31/07.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
04/30/2007
36 Months From Approved
01/31/2008
Responses
320
275
320
Time Burden (Hours)
480
1,100
480
Cost Burden (Dollars)
3,000
2,578
3,000
Abstract:
The Public Safety Officers Death Benefits (PSOB) Program provides a one-time benefit of $295,194.00 to the eligible survivors of local, state and federal public safety officers whose deaths result from traumatic injuries substained in the line of duty. The agency requires the information requested on this form to identify survivors and determine their eligibility for the Public Safety Officer Death Benefit in accordance with the statutory requirements found in 42 USC Sec. 3796. Respondents include surviving spouses, children and/or parents of deceased public safety officers.
Authorizing Statute(s):
US Code: 42 USC 3796 Name of Law: Public Safety Officers Benefits
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:
72 FR 9587
03/02/2007
30-day Notice:
Federal Register Citation:
Citation Date:
72 FR 25783
05/07/2007
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
CLAIM FOR DEATH BENEFITS
OJP FORM 3650/5
CLAIM FOR DEATH BENEFITS
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Increase documentation is required for the one time payment. Decrease in applicants is normal. A major increase in the number of applicants in the prior years were due to the terrorist attack on Sept 11, 2001. Many public safety officers were killed in the line of duty.
Annual Cost to Federal Government:
$42,413
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [PPACA, P.L. 111-148 & 111-152]?
Uncollected
Is this ICR related to the Dodd-Frank Act [Dodd-Frank Wall Street Reform and Consumer Protection Act, P.L. 111-203]?
Uncollected
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
Uncollected
Agency Contact:
Maria Pressley 202-353-8643 maria.pressley@usdoj.gov
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:
05/21/2007
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