Certification of Qualifying State Relief from Disabilities Program

OMB 1140-0094

OMB 1140-0094

This form is used by a State to certify to the U.S. Department of Justice, Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) that it has established a qualifying mental health relief from firearms disabilities program, based on certain minimum criteria established by the NICS Improvement Amendment Act of 2007, Public Law 110-180, Section 105, enacted January 8, 2008 (NIAA). This certification is required for States to be eligible for certain grants authorized by the NIAA.

The latest form for Certification of Qualifying State Relief from Disabilities Program expires 2022-08-31 and can be found here.


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