This bill mandates the President to establish a Medal of Sacrifice for law enforcement officers and first responders who are killed in the line of duty. Eligibility for the medal extends to local, State, Tribal, territorial, or Federal personnel, with a crucial exception: those subject to an official finding of wrongdoing are generally ineligible. A newly established Commission is tasked with investigating such cases and making the final determination on eligibility. The President is required to establish a 12-member Commission, comprising law enforcement officers, first responders, and relevant experts, within 150 days of enactment. This Commission will have several key responsibilities, including advising on the medal's design, promoting its establishment, and determining the presentation method. It will also make final eligibility decisions in cases of alleged wrongdoing and advise the President on criteria, with specific initial recipients named and a detailed medal description provided.