CLAIM FOR DISABILITY INSURANCE BENEFITS SURANCE

ICR 197512-2900-003

OMB: 2900-0016

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
146534 Migrated
ICR Details
2900-0016 197512-2900-003
Historical Active 197503-2900-018
VA
CLAIM FOR DISABILITY INSURANCE BENEFITS SURANCE
Revision of a currently approved collection   No
Regular
Approved without change 01/05/1976
Retrieve Notice of Action (NOA) 12/18/1975
  Inventory as of this Action Requested Previously Approved
01/31/1981 01/31/1981 08/31/1979
35,000 0 35,000
70,000 0 70,000
0 0 0



None
None


No

1
IC Title Form No. Form Name
CLAIM FOR DISABILITY INSURANCE BENEFITS SURANCE 29-357

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 35,000 35,000 0 0 0 0
Annual Time Burden (Hours) 70,000 70,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (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;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
12/18/1975


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