The Public Safety Officers Benefits
(PSOB) Program provides a one-time benefit of $250,000 to the
eligible survivors of local, state and federal public safety
officers whose deaths result from traumatic injuries substained in
the line of duty. The agency requires the information requested on
this form to identify survivors and determine their eligibility for
the Public Safety Officer Death Benefit in accordance with the
statutory requirements found in 42 USC Sec. 3796. Respondents
include surviving spouses, children and/or parents of deceased
public safety officers.
US Code:
42
USC 3796 Name of Law: The Public Safety Officers Benefits
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.