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, 725 17th Street NW,
Washington, DC 20503.
1. Agency/Subagency originating request

b. ✔ None

2. OMB control number
a. __ 1110
__ __ __ __ - _

FBI/CJIS
3. Type of information collection (check one)

__ __ __ __

4. Type of review requested (check one)
a. ✔ Regular

a. ✔ New Collection
b.

Revision of a currently approved collection

b.

Emergency - Approval requested by: ____/____/____

c.
d.

Extension of a currently approved collection
Reinstatement, without change, of a previously approved

c.

Delegated

e.

collection for which approval has expired
Reinstatement, with change, of a previously approved

5. Small entities
Will this information collection have a significant economic impact on a
substantial number of small entities?

collection for which approval has expired

Yes

f. ✔ Existing collection in use without an OMB control number

No

✔

6. Requested expiration date

For b-f, note Item A2 of Supporting Statement instructions

a.

✔

Three years from the approval date

b.

_____/_____

7. Title

Flash/Cancellation/Transfer Notice
8. Agency form number(s) (if applicable)

I-12
9. Keywords

Mandatory Release, Supervised Release, Probation, Parole, Special Parole Term (SPT), Pre-Trial Diversion (PTD), Transfer
10. Abstract
DOJ's CJIS is requesting a PRA approval for an existing collection in use without an OMB control number utilized by authorized agencies to indicate on an individual's identity history that the individual is being supervised
to ensure the supervisory agency is notified of any additional criminal activity. The form is also utilized by authorized agencies to submit information to advise the FBI that an individual is being transferred to a a new locale.

11. Affected public (Mark primary with "P" and all others with "X")

12. Obligation to respond (Mark primary with "P" and all others that apply with "X")

a. __ Individuals or households

d. __ Farms

a.

Voluntary

b. __ Business or other for-profit

e. P
__ Federal Government

b.

Required to obtain or retain benefits

c. __ Not-for-profit institutions

f. P
__ State, Local, or Tribal Government

13. Annual reporting and recordkeeping hour burden
a. Number of respondents
b. Total annual responses

a. Total annualized capital/startup costs

6,104
192,998

b. Total annual costs (O&M)

1. Percentage of these responses

c. Total annualized cost requested

N/A
c. Total annual hours requested 25,733
0
d. Current OMB inventory
N/A
e. Difference
collected electronically

%

f. Explanation of difference
1. Program change

e. Difference

N/A
780,780
N/A
0
N/A

f. Explanation of difference
1. Program change

N/A
N/A

N/A
N/A

16. Frequency of recordkeeping or reporting(check all that apply)
a. ✔ Recordkeeping

that apply with "X")
b. __ Program evaluation

d. Current OMB inventory

2. Adjustment

2. Adjustment
15. Purpose of information collection (Mark primary with "P" and all others
a. __ Application for benefits

c. P Mandatory
14. Annual reporting and recordkeeping cost burden(in thousands of dollars)

e. __ Program planning or management c. ✔ Reporting:
f. __ Research
1. ✔ On occasion

c. __ General purpose statistics g. P
__ Regulatory or compliance
d. __ Audit

4.
7.

Quarterly
Biennially

b. ✔ Third party disclosure
2.

Weekly

5.
8.

Semi-annually 6.
Annually
Other (describe) ____________

3.

Monthly

18. Agency contact (person who can best answer questions regarding the content

17. Statistical methods
Does this information collection employ statistical methods?
Yes

No ✔

of this submission)
Gerry Lynn Brovey, Supervisory Information Liaison Specialist
Name: ______________________________________________________

(304) 625-4320
Phone: ______________________________________________________
OMB 83-I

10/95