83i

PA PERW ORK REDUCTION A CT SUBM ISSION

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

2. OM B control nu mbe r
a. 1

FBI/CJIS

1

1

0

-

0 0

b.

3. Type of information collection (check one)
a.
New collection
b. ✔
Revision of a currently approved collection
c.
Extension, without change, 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. ✔ Regular
b.
Em ergency - A pproval reque sted by:
c.
Delegated

3a. Public C omm ents
Has the agency received public comments on this information collection?

6. Requ ested expiration d ate
a. ✔ Three years from approval date

✔

Yes

None

6 7

/

/

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

b.

Other Specify:

/

No

7. Title

Rap Back Services Form
8. Agenc y form num ber(s) (if applicable)

1-796
9. Keywords

Rap Back
10. Abstract

DOJ's CJIS is requesting approval for a currently approved collection utilized by authorized agencies to enroll individuals in
the Rap Back Service to ensure the submitting agency is notified when individuals in positions of trust engage in criminal
conduct or individuals under the supervision of a criminal justice agency commit subsequent criminal acts.
11. Affected public (Mark primary with "P" and all others that apply with "X")
a.
Individuals or households
b. X Bus iness or othe r for-pro fit
c.
Not-for-profit institutions

d.
F a rm s
e. X Federal Government
f. X State, Local or T ribal Govern men t

13. Annual reporting and recordkeeping hour burden
12
a. Num ber of respond ents
12
b. Total annual responses
1.Percentage of these responses

collected electronically
N/A
c. Total annual hours requested 1
d. Current O MB inventory
300
e. Difference
299
f. Explanation of difference
1. Program change N/A
Yes
2. Adjustment
15. Purpose of information collection
others that apply with "X")

Application for be nefits
a.
Program evaluation
b.
c.
General purpose statistics
Aud it
d.

%

(M ark prim ary with "P " an d all
e.
f.
g.

P

Program planning or management
Research
Regulatory or compliance

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

✔

No

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

P

Voluntary
Required to obtain or retain bene fits
Mand atory

14. Annual reporting and recordkeeping cost burden (in thousands of dollars)
N/A
a. Total annualized capital/startup costs
0
b . T o ta l a nn ua l c os ts (O & M )
c. Total annualized cost requested

N/A
d. Current O MB inventory
53,802
e. Difference
53,802
f. Explanation of difference
N/A
1. Program change
2. Adjustment
Yes

16. Frequency of recordkeeping or reporting (check all that apply)
a. ✔ Reco rdkeeping
b.
Third party disc losure
c.
Reporting
On occ asion
Wee kly
Mo nthly
1.
2.
3.
Sem i-annually 6.
Ann ually
4.
Quarterly
5.
Other (de scribe)
7.
Biennially
8.
18. Agen cy contact (person who can bes t ans we r qu es tion s reg ard ing the c on ten t of this
submission)
Nam e:

GerryLynn Brovey, Supervisory Information Liaison Specialist

Phone: (304) 625-4320

OMB 83-I

02/04

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 terminology that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f)

It indicates the retention period for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8(b)(3):
(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;

(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; 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

OMB 83-I

Date

02/04