View Information Collection Request (ICR) Package

OMB Control No: 1105-0092	ICR Reference No: 201201-1105-002
Status: Historical Active	Previous ICR Reference No: 201109-1123-001
Agency/Subagency: DOJ/LA	Agency Tracking No:
Title: September 11th Victim Compensation Fund Claimant Registration Form
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Emergency	Approval Requested By: 10/28/2011
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/12/2012
	Date Received in OIRA: 01/12/2012
Terms of Clearance: For the renewal of this package, DOJ will break the burden up by form in ROCIS.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2012	6 Months From Approved
Responses	70,000	0	70,000
Time Burden (Hours)	700,000	0	23,100
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 Eligibility and Compensation Form is requested given the high-profile and time-sensitive nature of this program. The Final Rule governing the administration of the Fund, which was published in the Federal Register on August 31, 2011, was effective October 3, and claimants have begun to register for the Fund. Emergency approval is needed in order to begin processing compensation claims as soon as possible. Absent emergency approval, eligible claimants would have to wait substantially longer to begin filing their claims, thereby impairing Congresss goal of providing compensation in as expeditious a manner as possible (as evidenced by the short statutory deadline for implementation). Such a delay in implementing the compensation process would clearly be contrary to the public interest. In addition, 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 date is consistent with the priorities of the Administration and the Funds Special Master. Timeline The following timeline is based on receiving emergency approval of the form. October 28, 2011 Make Eligibility Form available to the public. Late November 2011 Make Compensation Form available to the public

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	OMB Number 1123-0012, OMB Number 1123-0012, OMB Number 1123-0012, OMB Number 1123-0012	, , ,

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	70,000	70,000	0
Annual Time Burden (Hours)	700,000	23,100	676,900
Annual Cost Burden (Dollars)	0	0	0

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: An adjustment made to the calculations.

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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