83i

PAPERWORK REDUCTION ACT SUBMISSION
Please read the instructions before completing this form. For additional forms or assistance in completing this form contact your agency's Paperwork Clearance Officer. Send
two copies of this form, the collection instrument to be reviewed, the Supporting Statement, and any additional documentation to: Office of Information and Regulatory Affairs,
Office of Management and Budget, Docket Library, Room 10102, 72 17th Street NW, Washington, DC 20503.
1. Agency/Subagency originating request
DOJ, FBI , CJIS

2. OMB control number
a. 1 1 1 0 - 0 0 0 2

3. Type of information collection (check one)
a.
New collection
b. T Revision of a currently approved collection
c. __ Extension of a currently approved collection
d.
Reinstatement, without change, of a previously approved
collection for which approval has expired
e.
Reinstatement, with change, of a previously approved
collection for which approval has expired
f.
Existing collection in use without an OMB control number

4. Type of review requested (check one)
a. T Regular
b.
Emergency - Approval requested by: ___/___/___
c.
Delegated

3a. Public Comments
Has the agency received public comments on this information collection?
Yes T No

b. Q None
__ __ __ __

5. Small entities
Will this information collection have significant economic impact
on a substantial number of small entities?
Yes T No

6. Requested expiration date
a. T Three years from the approval date
b.
Other Specify: ____/____

7. Title Supplementary Homicide Report
8. Agency form number(s) (if applicable) 1-704
9. Keywords Homicide, Manslaughter, Murder
10. Abstract Provides specific incident data related to murder and nonnegligent manslaughters. Data are published annually in Crime in the

United States.
11. Affected public (M ark prim ary with "P" and all others that apply with "X")
a.
Individuals or households
d.
Farms
b.
Business or other for profit e. x Federal Government
c.
Not-for-profit institutions
f. P State, Local, or Tribal Government

12. Obligation to respond (M ark prim ary with "P" and all others that apply with "X")
a. P Voluntary
b.
Required to obtain or retain benefits
c.
Mandatory

13. Annual reporting and recordkeeping hour burden
a. Number of respondents
b. Total annual responses
1. Percentage of these responses
collected electronically
c. Total annual hours requested
d. Current OMB Inventory
e. Difference
f. Explanation of difference
1. Program Change
2. Adjustment

14. Annual reporting and recordkeeping cost burden (in thousands of dollars)
a. Total annualized capital/startup costs
0
b. Total annual costs (O&M)
0
c. Total annualized cost requested
0
d. Current OMB Inventory
0
e. Difference
0
f. Explanation of difference
1. Program Change
2. Adjustment
0

17,985
215,820
88 %
32,373
20,465
+11,908

+11,908

15. Purpose of information collection (Mark primary with "P" and all others
that apply with "X")
a.
Application for benefits
e.
Program planning or management
b.
Program Evaluation
f. X Research
c. P General Purpose Statistics
g.
Regulatory or Compliance
d.
Audit

16. Frequency of recordkeeping or reporting (check all that apply)
a.
Recordkeeping
b.
Third Party Disclosure
c. T Reporting
1. 9 On occasion 2. 9 Weekly
3. : Monthly
4. 9 Quarterly
5. 9 Semi-annually 6. 9 Annually
7. 9 Biennially
8. 9 Other (describe) ____________

17. Statistical Methods
Does this Information Collection employ statistical methods?

18. Agency contact (person who can best answer questions regarding the content of
this submission)

9 Yes

: No

Name: Patricia S. Faulkner
Phone: (304) 625-2957

OM B 83-I

Date: January 12, 2011
10/95

19. Certification for Paperwork Reduction Act Submissions
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with
5 CFR 1320.9.

NOTE:

The text of 5 CFR 1320.9, and the related provisions of 5 CFR 1320.8(b)(3), appear at the end of the
instructions. The certification is to be made with reference to those regulatory provisions as set forth in
the instructions.

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) W hy the information is being collected;
(ii) Use of information;
(iii) Burden of estimate;
(iv) Nature of response (voluntary, required for benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OM B 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 (see note in Item 19 of the instructions);
(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 below and explain the reason in
Item 18 of the Supporting Statement.

Signature of Senior Official or designee

OM B 83-I

Date

10/95