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OMB Control No: 1105-0109	ICR Reference No: 202609-1105-002
Status: Received in OIRA	Previous ICR Reference No: 202309-1105-002
Agency/Subagency: DOJ/LA	Agency Tracking No: 1105-0109
Title: Procurement Collusion Strike Force Complaint Form
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 10/07/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	11/30/2026
Responses	100	45
Time Burden (Hours)	75	23
Cost Burden (Dollars)	1,768	0

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	100	45	55
Annual Time Burden (Hours)	75	23	52
Annual Cost Burden (Dollars)	1,768	0	1,768

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: The adjusted burden is due to a miscalculation and increased number of estimated respondents based on the actual number of responses since the previous submission.

Annual Cost to Federal Government: $1,326

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. 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? No

Agency Contact: Sarah Oldfield 202 305-8915

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