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 tv..u 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,
Washinqton,

DC 20503.

a.

DOJIFBIICJIS Division

c.iT

ExtenSion,

Reinstatement,

E

without change,

of a currently

without change,

approved

of a previously

collection

approved

collection

Existing collection

f.1:

in use without an OMS control

----

C None

0060

--

----

--

--'--'--

for

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

eC

_

1110

4. Type of review requested (check one)
a. !I: Regular
b. C. Emergency - Approval requested by:
c. C Delegated

3. Type of information collection (check one)
New collection
aC
Revision of a currently approved collection
bl
d.

b.

2. OM B control number

1. Agency'Subagency originating request

5. Small entities
Will this information
substantial

number

collection

have a significant

of small entities?

number

-

economic

impact

on a

!.._ No

Yes

6. Requested expiration date

3a. Public Comments
Has the agency received

public comments

on this information

collection?

a.

.E Three

years from approval

date

b._[' Other Specify: ___

' ___

, No

Yes
7. Title

CllS Biographic Verification Request Form
8. Agency form num ber(s) (if app'icable)

1-791
9. Keywords

Biometric Identification, Biometric Verification
10. Abstract

The CllS Division is requesting PRA approval for the extension ofa currently approved collection. The ellS Biographic Verification Request
Form is required from a noncriminal justice agency to recieve the benefit of a biographic verification in an attempt to obtain adjudicated
criminal history information (for determining benefits, licensing, or employment) in cases where the required fingerprint image quality could
not be achieved after two attempts for a fingerprint-based
search.
11. Affected public (Mark primary
a

-

Individuals

with

"po and all others

or households

b ...!:... Business or other for-profit
c._ Not-for-profit institutions

that

apply

with

"X")

a. _

1.1:... State, Local or Tribal Government

c. _

that apply

a. _Application
b. _Program

f. Explanation

1.667

1. Program

467

c. _General

for benefits

purpose

statistics

with "P" and all

e. _Program

f.

planning

- Research

g. ~Regulatory

or management

or compliance

cost requested

of dollars)

0
0
·0

of difference
change
_ We cannot calculate

rcspondcl1I salaries.

16. Frequency of recordkeeping or reporting (check all that apply)
b. _Third party disclosure
a. !_Recordkeeping
c. !.._Reporting
3. _Monthly
2. _Weekly
1 . .!_On occasion
Annuallv
6.
5. _Semi-annually
4. _Quarterly
8. _Other (describe)
7. _Biennially
18. Agency contact (person

17. Statistical methods
collection

"X")

responses expected.

d _Audit

Does this information

with

to obtain or retain benefits

2. Adjustment

with "X")

evaluation

Required

e. Difference

15. Purpose of information collection (Mark primary
others

that apply

Mandatory

d. Current OMB inventory

1.200

Fewer

X

c. Total annualized

of these respnn!'>p.~
100

collected electronically

c. Total annual hours requested
d. Current OMB inventory
e. Difference
I. Explanation of differenr,p
1. Program change ____
2. Adjustment

b.

with "P" and all others

Voluntary

14. Annual reporting and recordkeeping cost burden lin thousands
0
a. Total annualized capital/startup costs
0
b Total annual costs (O&M)

13. Annual reporting and recordkeepinp hOI" hlJrrip.n
-430
a. Number of respondents
-36.000
b. Total annual responses
1.Percentage

12. Obligation to respond (Mark primary

d.
- Farms
e. P Federal Govemment

employ

statistical

- Yes

methods?

!.._ No

who can best answer

questions

regarding

the content

of this

submission)
Name:

ChrislOpher G. Vandevender

Phone: 304-625-5789

OMB 83-1

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

U)

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.

Date

5
OMB 83-1

02/04