The information collected is pursuant
to the Public Safety Officers' Benefit Act of 1976 to determine the
eligibility of permanently and totally disabled public safety
officers for the payment of benefits. The form includes information
necessary to determine that the circumstances that lead to the
disability meet the requirements prescribed in 42 U.S.C. Sec.
3796.
Average number of applicants
has changed from 75 to 100 because of the increase in applications
for disability.
$14,798
No
No
No
Uncollected
No
Uncollected
Maria Pressley 202-353-8643
maria.pressley@usdoj.gov
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:
(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;
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.