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OMB Control No: 1123-0012	ICR Reference No: 201109-1123-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOJ/CD	Agency Tracking No:
Title: September 11th Victim Compensation Fund Claimant Registration Form
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Emergency	Approval Requested By: 10/03/2011
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/29/2011
	Date Received in OIRA: 09/27/2011
Terms of Clearance: Please note the revised emergency justification document in the supplementary documents section. This document serves as the final emergency justification.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2012	6 Months From Approved
Responses	70,000	0	0
Time Burden (Hours)	23,100	0	0
Cost Burden (Dollars)	0	0	0

Abstract: Under the James Zadroga September 11 Health and Compensation Act of 2010 (P.L. 111-347), the Department of Justice would request biographical information and limited information regarding eligibility for the September 11th Victim Compensation Fund from potential claimants in order to begin the process of determining whether claimants will be eligible for compensation from the Fund.

Emergency Justfication: Justification for Emergency Approval Request Emergency approval of the September 11th Victim Compensation Fund Claimant Registration Form is requested given the high-profile and time-sensitive nature of this program. The Attorney General has publicly stated that the Fund will be up and running at the beginning of October. Additionally, the Final Rule governing the administration of the Fund, which was published in the Federal Register on August 31, 2011, is effective October 3. Thus, it is important to make the registration form publically available by that time. Delaying the publication of the forms associated with the Victim Compensation Fund will prevent the Department from accomplishing its stated goal of allowing victims to begin to submit claims in October 2011. Meeting this intended start date is consistent with the priorities of the Administration and the Funds Special Master. Timeline The PRA review period of 150 days is too long to keep potential claimants waiting to apply for compensation. The following timeline is based on receiving emergency approval of the form. October 3, 2011 Make Registration Form available to the public. October/November 2011 Review Registration Forms and publish remaining parts of claim forms

Authorizing Statute(s): PL: Pub.L. 111 - 347 404 Name of Law: James Zadroga 9/11 Health and Compensation Act of 2010

Citations for New Statutory Requirements: PL: Pub.L. 111 - 347 404 Name of Law: James Zadroga 9/11 Health and Compensation Act of 2010

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1105-AB39	Final or interim final rulemaking	76 FR 54112	08/31/2011

Federal Register Notices & Comments
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
September 11th Victim Compensation Registration Form

ICR Summary of Burden

	Total Approved	Change Due to New Statute
Annual Number of Responses	70,000	70,000
Annual Time Burden (Hours)	23,100	23,100
Annual Cost Burden (Dollars)	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: New Collection.

Annual Cost to Federal Government:

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 [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? Uncollected

Agency Contact: Kenneth zwick 202 514-4552 kenneth.zwick@usdoj.gov

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