83966 Federal Register / Vol. 88, No. 230 / Friday, December 1, 2023 / Notices 

—Enhance the quality, utility, and 

clarity of the information to be 

collected; and/or 

—Minimize the burden of the collection 

of information on those who are to 

respond, including through the use of 

appropriate automated, electronic, 

mechanical, or other technological 

collection techniques or other forms 

of information technology, e.g., 

permitting electronic submission of 

responses. 

Written comments and 

recommendations for this information 

collection should be submitted within 

30 days of the publication of this notice 

on the following website 

www.reginfo.gov/public/do/PRAMain. 

Find this particular information 

collection by selecting ‘‘Currently under 

30-day Review—Open for Public 

Comments’’ or by using the search 

function and entering either the title of 

the information collection. This 

information collection request may be 

viewed at www.reginfo.gov. Follow the 

instructions to view Department of 

Justice, information collections 

currently under review by OMB. 

DOJ seeks PRA authorization for this 

information collection for three (3) 

years. OMB authorization for an ICR 

cannot be for more than three (3) years 

without renewal. The DOJ notes that 

information collection requirements 

submitted to the OMB for existing ICRs 

receive a month-to-month extension 

while they undergo review. 

Overview of This Information 

Collection 

1. Type of Information Collection: 

New collection. 

2. Title of the Form/Collection: 

Authorization for Release of Medical 

Information. 

3. Agency form number, if any, and 

the applicable component of the 

Department of Justice sponsoring the 

collection: There is no agency form 

number for this collection. The 

applicable component within the 

Department of Justice is the Office of the 

Pardon Attorney. 

4. Affected public who will be asked 

or required to respond, as well as a brief 

abstract: Affected Public: Individuals or 

households. 

Abstract: The information collected 

from the Authorizations for the Release 

of Medical Information will primarily be 

used to make recommendations 

regarding executive clemency and 

ensure proper notification to the Federal 

Bureau of Investigation, U.S. Attorneys’ 

Offices, U.S. Probation Offices, and 

federal courts in the event of grants of 

executive clemency. The Authorization 

for the Release of Medical Information 

will only be collected once per 

application for clemency. 

5. Obligation To Respond: Voluntary. 

6. Total Estimated Number of 

Respondents: 1,000 applicants. 

7. Estimated Time per Respondent: 

Five minutes. 

8. Frequency: Once. 

9. Total Estimated Annual Time 

Burden: 84 hours. 

10. Total Estimated Annual Other 

Costs Burden: Approximately 700 

applicants are expected to mail in the 

Authorization for the Release of Medical 

Information, incurring a $.63 postage fee 

for each submission. This results in a 

total estimated cost burden of $441. 

Applicants will not incur any capital, 

start-up, or system maintenance costs 

associated with this information 

collection. 

If additional information is required, 

contact: Darwin Arceo, Department 

Clearance Officer, Policy and Planning 

Staff, Justice Management Division, 

United States Department of Justice, 

Two Constitution Square, 145 N Street 

NE, 4W–218, Washington, DC 20530. 

Dated: November 28, 2023. 

Darwin Arceo, 

Department Clearance Officer for PRA, U.S. 

Department of Justice. 

[FR Doc. 2023–26431 Filed 11–30–23; 8:45 am] 

BILLING CODE 4410–29–P 

DEPARTMENT OF JUSTICE 

[CPCLO Order No. 005–2023] 

Privacy Act of 1974; Systems of 

Records 

AGENCY: Department of Justice. 

ACTION: Notice of a new system of 

records. 

SUMMARY: Pursuant to the Privacy Act of 

1974 and Office of Management and 

Budget (OMB) Circular No. A–108, 

notice is hereby given that the United 

States Department of Justice (DOJ or 

Department) proposes to develop a new 

system of records titled National Law 

Enforcement Accountability Database, 

JUSTICE/DOJ–022. The Department 

proposes to establish this system of 

records to promote new and 

strengthened practices in the hiring, 

promotion, and retention of law 

enforcement officers. On May 25, 2022, 

the President issued an Executive Order, 

Advancing Effective, Accountable 

Policing and Criminal Justice Paractices 

to Enhance Public Trust and Public 

Safety (the ‘‘Executive Order’’). Section 

5 of the Executive Order directs the 

Attorney General to establish a National 

Law Enforcement Accountability 

Database (the ‘‘NLEAD’’) documenting 

instances of law enforcement officer 

misconduct, commendations, and 

awards. The Attorney General shall also 

ensure that the NLEAD is consistent 

with all applicable laws, including the 

Privacy Act, and respects appropriate 

due process protections for law 

enforcement officers. 

DATES: In accordance with 5 U.S.C. 

552a(e)(4) and (11), this notice is 

effective upon publication, subject to a 

30-day period in which to submit 

comments. Please submit any comments 

by January 2, 2024. 

ADDRESSES: The public, OMB, and 

Congress are invited to submit any 

comments by mail to the United States 

Department of Justice, Office of Privacy 

and Civil Liberties, ATTN: Privacy 

Analyst, Two Constitution Square, 145 

N St. NE, Suite 8W–300, Washington, 

DC 20530; by facsimile at 202–307– 

0693; or by email at 

privacy.compliance@usdoj.gov. To 

ensure proper handling, please 

reference the above CPCLO Order No. 

on your correspondence. 

FOR FURTHER INFORMATION CONTACT: 

Brian Merrick, Deputy Director, Service 

Delivery Staff, United States Department 

of Justice, Justice Management Division, 

Two Constitution Square, 145 N St. NE, 

Suite 4W–202, Washington, DC 20530; 

Brian.Merrick@usdoj.gov, 202–514– 

0070. 

SUPPLEMENTARY INFORMATION: In 

Executive Order 14074, the President 

declared a policy that strives to 

‘‘strengthen public safety and the bonds 

of trust between law enforcement and 

the community and build a criminal 

justice system that respects the dignity 

and equality of all in America.’’ As 

explained in the Executive Order, one of 

the many ways to advance that policy is 

to ‘‘commit to new practices in law 

enforcement recruitment, hiring, 

promotion, and retention, as well as 

training, oversight, and accountability.’’ 

In furtherance of these goals, Section 5 

of the Executive Order directs the 

Attorney General to establish the 

NLEAD for official records documenting 

law enforcement officer misconduct, 

commendations, and awards. Section 5 

provides that the NLEAD include, to the 

maximum extent permitted by law, the 

following categories of records 

documenting: criminal convictions; 

suspension of a law enforcement 

officer’s enforcement authorities, such 

as de-certification; terminations; civil 

judgments related to official duties, 

including amounts if publicly available; 

resignations or retirements while under 

investigation for serious misconduct; 


lotter on DSK11XQN23PROD with NOTICES1
Federal Register / Vol. 88, No. 230 / Friday, December 1, 2023 / Notices 83967 

and sustained complaints or records of 

disciplinary action based on findings of 

serious misconduct. The NLEAD shall 

also include official records 

documenting officer commendations 

and awards, as the Attorney General 

deems appropriate. 

Pursuant to Section 5(e) of the 

Executive Order, the NLEAD shall be 

used, as appropriate and consistent with 

applicable law, in the hiring, job 

assignment, and promotion of Federal 

law enforcement officers, as well as in 

the screening of State, Tribal, local, and 

territorial law enforcement officers who 

participate in programs or activities 

controlled by Federal law enforcement 

agencies, such as joint task forces or 

international training and technical 

assistance programs, including 

programs managed by the Department of 

State and the DOJ. State, Tribal, local, 

and territorial law enforcement agencies 

are encouraged to contribute to and use 

the NLEAD in a manner consistent with 

applicable law. 

The Department proposes to establish 

the NLEAD system of records to fulfill 

the mandate of the Executive Order and 

facilitate new and strengthened hiring 

practices while protecting the safety, 

privacy, and due process rights of law 

enforcement officers who may be 

identified in the NLEAD. 

In accordance with 5 U.S.C. 552a(r), 

the Department has provided a report to 

OMB and Congress on this new system 

of records. 

Dated: November 20, 2023. 

Peter A. Winn, 

Acting Chief Privacy and Civil Liberties 

Officer, United States Department of Justice. 

JUSTICE/DOJ–022 

SYSTEM NAME AND NUMBER: 

National Law Enforcement 

Accountability Database, JUSTICE/DOJ– 

022. 

SECURITY CLASSIFICATION: 

Controlled unclassified information. 

SYSTEM LOCATION: 

Records will be maintained by a 

Department-authorized cloud service 

provider and the records will be 

required to be maintained within the 

Continental United States. Records can 

be accessed from all locations at which 

DOJ System Managers operate or are 

supported, including the Two 

Constitution Square building, 145 N 

Street NE, Washington, DC 20530. 

Some or all system information may 

be duplicated at other locations where 

the Department has granted direct 

access to support DOJ System Manager 

operations, system backup, emergency 

preparedness, and/or continuity of 

operations. For more specific 

information about the location of 

records maintained in this system of 

records, contact the system manager 

using the contact information listed in 

the ‘‘SYSTEM MANAGER(S)’’ 

paragraph, below. 

SYSTEM MANAGER(S): 

DOJ Chief Information Officer, (202) 

514–3101, 145 N Street NE, Washington, 

DC 20530. 

AUTHORITY FOR MAINTENANCE OF THE SYSTEM: 

5 U.S.C. 3301; Executive Order 13764, 

Amending the Civil Service Rules, 

Executive Order 13488, and Executive 

Order 13467 To Modernize the 

Executive Branch-Wide Governance 

Structure and Processes for Security 

Clearances, Suitability and Fitness for 

Employment, and Credentialing, and 

Related Matters; and Executive Order 

14074, Advancing Effective, 

Accountable Policing and Criminal 

Justice Practices to Enhance Public 

Trust and Public Safety. 

PURPOSE(S) OF THE SYSTEM: 

Records in this system will be used by 

Federal law enforcement agencies to 

assess the loyalty, trustworthiness, 

suitability, and/or eligibility of an 

individual for hiring, job assignment, or 

promotion as a law enforcement officer, 

as well as the screening of State, Tribal, 

local and territorial law enforcement 

officers who participate in programs or 

activities over which Federal agencies 

exercise control, such as joint task 

forces or international training and 

technical assistance programs. 

CATEGORIES OF INDIVIDUALS COVERED BY THE

SYSTEM: 

Current and former law enforcement 

officers, including but not limited to full 

and part-time employees, detailees, and 

task force personnel. 

CATEGORIES OF RECORDS IN THE SYSTEM: 

Identifying information regarding the 

law enforcement officers in the 

Categories of Individuals above, 

including records, or indications of the 

existence of records, relating to: (i) 

criminal convictions; (ii) suspension of 

a law enforcement officer’s enforcement 

authorities, such as de-certification; (iii) 

terminations; (iv) civil judgments, 

including amounts (if publicly 

available), related to official duties; (v) 

resignations or retirement while under 

investigation for serious misconduct; 

(vi) sustained complaints or records of 

disciplinary action based on findings of 

serious misconduct; and (vii) 

commendations and awards. 

RECORD SOURCE CATEGORIES: 

Sources of information contained in 

this system are individuals and entities 

at law enforcement agencies and the 

individuals listed in the Categories of 

Individuals above. 

ROUTINE USES OF RECORDS MAINTAINED IN THE

SYSTEM, INCLUDING CATEGORIES OF USERS AND

THE PURPOSES OF SUCH USES: 

In addition to those disclosures 

generally permitted under 5 U.S.C. 

552a(b), all or a portion of the records 

or information contained in this system 

of records may be disclosed as a routine 

use pursuant to 5 U.S.C. 552a(b)(3) 

under the circumstances or for the 

purposes described below, to the extent 

such disclosures are compatible with 

the purposes for which the information 

was collected: 

(a) Designated officers and employees 

of agencies, offices, and other 

establishments in the executive, 

legislative, and judicial branches of the 

Federal Government, in connection with 

the hiring or continued employment of 

an employee or contractor, the conduct 

of a suitability or security investigation 

of an employee or contractor, or the 

grant, renewal, suspension, or 

revocation of a security clearance, to the 

extent that the information is relevant 

and necessary to the hiring agency’s 

decision. 

(b) Designated officers and employees 

of State or local (including the District 

of Columbia) law enforcement or 

detention agencies in connection with 

the hiring or continued employment of 

an employee or contractor, where the 

employee or contractor would occupy or 

occupies a position of public trust as a 

law enforcement officer, to the extent 

that the information is relevant and 

necessary to the recipient agency’s 

decision. 

(c) Federal, State, local, or private 

entities where appropriate for purposes 

of certification of security clearances of 

participants in training, conferences, 

meetings, facility visits, and similar 

activities. 

(d) To an organization or individual 

in the public or private sector where 

there is reason to believe the recipient 

is or could become the target of a 

particular criminal activity or 

conspiracy or other threat, to the extent 

the information is relevant to the 

protection of life, health, or property. 

Information may be similarly disclosed 

to other recipients who share the same 

interests as the target or who may be 

able to assist in protecting against or 

responding to the activity or conspiracy. 

(e) To appropriate officials and 

employees of a Federal agency for 

which the Department is authorized to 


lotter on DSK11XQN23PROD with NOTICES1
83968 Federal Register / Vol. 88, No. 230 / Friday, December 1, 2023 / Notices 

provide a service, when disclosed in 

accordance with an interagency 

agreement and when necessary to 

accomplish an agency function 

articulated in the interagency 

agreement. 

(f) To any person(s) or appropriate 

Federal, State, Tribal, local, territorial, 

or foreign law enforcement authority 

authorized to assist in an approved 

investigation of or relating to the 

improper usage of DOJ information 

technologies, information systems, and/ 

or networks. 

(g) To any criminal, civil, or 

regulatory law enforcement authority 

(whether Federal, State, Tribal, local, 

territorial, or foreign) where the 

information is relevant to the recipient 

entity’s law enforcement 

responsibilities. 

(h) To a governmental entity lawfully 

engaged in collecting law enforcement, 

law enforcement intelligence, or 

national security intelligence 

information for such purposes. 

(i) To any person, organization, or 

governmental entity in order to notify 

them of a serious terrorist threat for the 

purpose of guarding against or 

responding to such a threat. 

(j) To Federal, State, local, territorial, 

Tribal, foreign, or international 

licensing agencies or associations which 

require information concerning the 

suitability or eligibility of an individual 

for a license or permit. 

(k) Where a record, either alone or in 

conjunction with other information, 

indicates a violation or potential 

violation of law—criminal, civil, or 

regulatory in nature—the relevant 

records may be referred to the 

appropriate Federal, State, local, 

territorial, Tribal, or foreign law 

enforcement authority or other 

appropriate entity charged with the 

responsibility for investigating or 

prosecuting such violation or charged 

with enforcing or implementing such 

law. 

(l) To any person or entity that the 

Department has reason to believe 

possesses information regarding a 

matter within the jurisdiction of the 

Department, to the extent deemed to be 

necessary by the Department to elicit 

such information or cooperation from 

the recipient for use in the performance 

of an authorized activity. 

(m) In an appropriate proceeding 

before a court, grand jury, or 

administrative or adjudicative body, 

when the Department of Justice 

determines that the records are arguably 

relevant to the proceeding; or in an 

appropriate proceeding before an 

administrative or adjudicative body 

when the adjudicator determines the 

records to be relevant to the proceeding. 

(n) To an actual or potential party to 

litigation or the party’s authorized 

representative for the purpose of 

negotiation or discussion of such 

matters as settlement, plea bargaining, 

or in informal discovery proceedings. 

(o) To the news media and the public, 

including disclosures pursuant to 28 

CFR 50.2, unless it is determined that 

release of the specific information in the 

context of a particular case would 

constitute an unwarranted invasion of 

personal privacy. 

(p) To contractors, grantees, experts, 

consultants, students, and others 

performing or working on a contract, 

service, grant, cooperative agreement, 

interagency agreement, or other 

assignment for the Federal Government, 

when necessary to accomplish an 

agency function related to this system of 

records. 

(q) To a former employee of the 

Department for purposes of: responding 

to an official inquiry by a Federal, State, 

or local governmental entity or 

professional licensing authority, in 

accordance with applicable Department 

regulations; or facilitating 

communications with a former 

employee that may be necessary for 

personnel-related or other official 

purposes where the Department requires 

information and/or consultation 

assistance from the former employee 

regarding a matter within that person’s 

former area of responsibility. 

(r) To a Member of Congress or staff 

acting upon the Member’s behalf when 

the Member or staff requests the 

information on behalf of, and at the 

request of, the individual who is the 

subject of the record. 

(s) To the National Archives and 

Records Administration for purposes of 

records management inspections 

conducted under the authority of 44 

U.S.C. 2904 and 2906. 

(t) To appropriate agencies, entities, 

and persons when: (1) the Department 

suspects or has confirmed that the 

security or confidentiality of 

information in the system of records has 

been compromised; (2) the Department 

has determined that as a result of the 

suspected or confirmed compromise 

there is a risk of harm to economic or 

property interests, identity theft or 

fraud, or harm to the security or 

integrity of this system or other systems 

or programs (whether maintained by the 

Department or another agency or entity) 

that rely upon the compromised 

information; and (3) the disclosure 

made to such agencies, entities, and 

persons is reasonably necessary to assist 

in connection with the Department’s 

efforts to respond to the suspected or 

confirmed compromise and prevent, 

minimize, or remedy such harm. 

(u) To another Federal agency or 

entity, when the Department determines 

that information from this system of 

records is reasonably necessary to assist 

the recipient agency or entity in (1) 

responding to a suspected or confirmed 

breach or (2) preventing, minimizing, or 

remedying the risk of harm to 

individuals, the recipient agency or 

entity (including its information 

systems, programs, and operations), the 

Federal Government, or national 

security, resulting from a suspected or 

confirmed breach. 

(v) To any agency, organization, or 

individual for the purpose of performing 

authorized audit or oversight operations 

of the Department, and meeting related 

reporting requirements. 

(w) To such recipients and under 

such circumstances and procedures as 

are mandated by Federal statute or 

treaty. 

POLICIES AND PRACTICES FOR STORAGE OF

RECORDS: 

Records are maintained in electronic 

storage media, in accordance with the 

safeguards mentioned below. 

POLICIES AND PRACTICES FOR RETRIEVAL OF

RECORDS: 

Data is retrieved by searching an 

individual’s name, date of birth, and/or 

social security number. 

POLICIES AND PRACTICES FOR RETENTION AND

DISPOSAL OF RECORDS: 

The Department is working with the 

National Archives and Records 

Administration to create a records 

retention and disposal schedule for 

records in the NLEAD. 

ADMINISTRATIVE, TECHNICAL, AND PHYSICAL

SAFEGUARDS: 

Information in this system is 

safeguarded in accordance with 

appropriate laws, rules, and policies, 

including the Department’s automated 

systems security and access policies and 

Interconnection Security Agreements 

(ISAs) with Federal agency subscribers. 

Access to such information is limited to 

Department personnel, contractors, and 

other personnel who have an official 

need for access in order to perform their 

duties. Records are maintained in an 

access-controlled area, with direct 

access permitted to only authorized 

personnel. Electronic records are 

accessed only by authorized personnel 

with accounts on the Department’s 

network. Additionally, direct access to 

certain information may be restricted 

depending on a user’s role and 

responsibility within the organization 


lotter on DSK11XQN23PROD with NOTICES1
Federal Register / Vol. 88, No. 230 / Friday, December 1, 2023 / Notices 83969 

and system. Any electronic data that 

contains personally identifiable 

information will be encrypted in 

accordance with applicable National 

Institute of Standards and Technology 

standards when transferred between the 

Department and the subscriber agency. 

RECORD ACCESS PROCEDURES: 

A request for access to a record from 

this system of records must be 

submitted in writing and comply with 

28 CFR part 16, and should be sent by 

mail to the Justice Management 

Division, ATTN: FOIA Contact, Room 

1111, Robert F. Kennedy Department of 

Justice Building, 950 Pennsylvania 

Avenue NW, Washington, DC 20530– 

0001, or by email at JMDFOIA@

usdoj.gov. Correspondence should be 

clearly marked ‘‘Privacy Act Access 

Request.’’ The request should include a 

general description of the records 

sought, and must include the requester’s 

full name, current address, and date and 

place of birth. The request must be 

signed and dated and either notarized or 

submitted under penalty of perjury. 

While no specific form is required, 

requesters may obtain a form (Form 

DOJ–361) for certification of identity 

from the FOIA/Privacy Act Mail Referral 

Unit, Justice Management Division, 

United States Department of Justice, 950 

Pennsylvania Avenue NW, Washington, 

DC 20530–0001, or from the 

Department’s website at http://

www.justice.gov/oip/forms/cert_ind.pdf. 

More information regarding the 

Department’s procedures for accessing 

records in accordance with the Privacy 

Act can be found at 28 CFR part 16 

Subpart D, ‘‘Protection of Privacy and 

Access to Individual Records Under the 

Privacy Act of 1974.’’ 

CONTESTING RECORD PROCEDURES: 

Individuals seeking to contest or 

amend records maintained in this 

system of records must direct their 

requests to the physical or electronic 

address indicated in the ‘‘RECORD 

ACCESS PROCEDURES’’ paragraph, 

above. All requests to contest or amend 

records must be in writing and the 

correspondence (and envelope or email 

subject line) should be clearly marked 

‘‘Privacy Act Amendment Request.’’ All 

requests must state clearly and 

concisely what record is being 

contested, the reasons for contesting it, 

and the proposed amendment to the 

record. 

More information regarding the 

Department’s procedures for amending 

or contesting records in accordance with 

the Privacy Act can be found at 28 CFR 

16.46, ‘‘Requests for Amendment or 

Correction of Records.’’ 

NOTIFICATION PROCEDURES: 

Individuals may be notified if a record 

in this system of records pertains to 

them when the individuals request 

information utilizing the same 

procedures as those identified in the 

‘‘RECORD ACCESS PROCEDURES’’ 

paragraph, above. 

HISTORY: 

None. 

[FR Doc. 2023–26073 Filed 11–30–23; 8:45 am] 

BILLING CODE 4410–NW–P 

DEPARTMENT OF JUSTICE 

[OMB Number 1123–0NEW] 

Agency Information Collection 

Activities; Proposed eCollection 

eComments Requested; Authorization 

for Release of Medical Information— 

Mental Health 

AGENCY: Office of the Pardon Attorney, 

Department of Justice. 

ACTION: 30-Day notice. 

SUMMARY: The Office of the Pardon 

Attorney, Department of Justice (DOJ), 

will be submitting the following 

information collection request to the 

Office of Management and Budget 

(OMB) for review and approval in 

accordance with the Paperwork 

Reduction Act of 1995. The proposed 

information collection was previously 

published in the Federal Register on 

September 28, 2023, allowing a 60-day 

comment period. 

DATES: Comments are encouraged and 

will be accepted for 30 days until 

January 2, 2024. 

FOR FURTHER INFORMATION CONTACT: If 

you have comments especially on the 

estimated public burden or associated 

response time, suggestions, or need a 

copy of the proposed information 

collection instrument with instructions 

or additional information, please 

contact: Kira Gillespie, Deputy Pardon 

Attorney, Office of the Pardon Attorney, 

950 Pennsylvania Avenue NW, Main 

Justice—RFK Building, Washington, DC 

20530; kira.gillespie@usdoj.gov; (202) 

616–6073. 

SUPPLEMENTARY INFORMATION: Written 

comments and suggestions from the 

public and affected agencies concerning 

the proposed collection of information 

are encouraged. Your comments should 

address one or more of the following 

four points: 

—Evaluate whether the proposed 

collection of information is necessary 

for the proper performance of the 

functions of the agency, including 

whether the information will have 

practical utility; 

—Evaluate the accuracy of the agency’s 

estimate of the burden of the 

proposed collection of information, 

including the validity of the 

methodology and assumptions used; 

—Enhance the quality, utility, and 

clarity of the information to be 

collected; and/or 

—Minimize the burden of the collection 

of information on those who are to 

respond, including through the use of 

appropriate automated, electronic, 

mechanical, or other technological 

collection techniques or other forms 

of information technology, e.g., 

permitting electronic submission of 

responses. 

Written comments and 

recommendations for this information 

collection should be submitted within 

30 days of the publication of this notice 

on the following website 

www.reginfo.gov/public/do/PRAMain. 

Find this particular information 

collection by selecting ‘‘Currently under 

30-day Review—Open for Public 

Comments’’ or by using the search 

function and entering either the title of 

the information collection. This 

information collection request may be 

viewed at www.reginfo.gov. Follow the 

instructions to view Department of 

Justice, information collections 

currently under review by OMB. 

DOJ seeks PRA authorization for this 

information collection for three (3) 

years. OMB authorization for an ICR 

cannot be for more than three (3) years 

without renewal. The DOJ notes that 

information collection requirements 

submitted to the OMB for existing ICRs 

receive a month-to-month extension 

while they undergo review. 

Overview of This Information 

Collection 

1. Type of Information Collection: 

New collection. 

2. Title of the Form/Collection: 

Authorization for Release of Medical 

Information—Mental Health. 

3. Agency form number, if any, and 

the applicable component of the 

Department of Justice sponsoring the 

collection: There is no agency form 

number for this collection. The 

applicable component within the 

Department of Justice is the Office of the 

Pardon Attorney. 

4. Affected public who will be asked 

or required to respond, as well as a brief 

abstract: Affected Public: Individuals or 

households. 

Abstract: The information collected 

from the Authorizations for the Release 

of Medical Information—Mental Health 


lotter on DSK11XQN23PROD with NOTICES1