Medal of Valor Application

Public Safety Officer Medal of Valor Application

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0259 can be found here:

Documents and Forms

Document Name Document Type
Medal of Valor Application Form and Instruction
Medal of Valor application MEDAL OF VALOR APPLICATION.doc www.ojp.usdoj.gov//medalofvalor/welcome.html. Form and Instruction

Information Collection (IC) Details

IC Title:	Medal of Valor Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	Medal of Valor application	MEDAL OF VALOR APPLICATION.doc	http://www.ojp.usdoj.gov//medalofvalor/welcome.html.	Yes	Yes	Fillable Fileable

Line of Business: Law Enforcement

Subfunction: Leadership Protection

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 158	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	158	51	107
Annual IC Time Burden (Hours)	66	21	45
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.