APPLICATION FOR ORDINARY LIFE INSURANCE (AT AGE 70)

ICR 197606-2900-013

OMB: 2900-0202

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
147549 Migrated
ICR Details
2900-0202 197606-2900-013
Historical Active
VA
APPLICATION FOR ORDINARY LIFE INSURANCE (AT AGE 70)
Revision of a currently approved collection   No
Regular
Approved without change 06/30/1976
Retrieve Notice of Action (NOA) 06/22/1976
  Inventory as of this Action Requested Previously Approved
06/30/1981 06/30/1981
1,000 0 0
83 0 0
0 0 0

THE COMPLETED FORM IS REQUIRED BY LAW, U.S.C. 704. THE INFORMATION COLLECTED IS USED TO PROCESS THE INSURED'S REQUEST FOR REPLACEMENT INSURANCE FOR HIS/HER MODIFIED LIFE POLICY.

None
None


No

1
IC Title Form No. Form Name
APPLICATION FOR ORDINARY LIFE INSURANCE (AT AGE 70) 28-8485A

  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 1,000 0 0 0 1,000 0
Annual Time Burden (Hours) 83 0 0 0 83 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.
06/22/1976


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