STATEMENTS OF DEATH AND BURIAL EXPENSES BY FUNERAL DIRECTOR

ICR 197611-3220-001

OMB: 3220-0077

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
3220-0077 197611-3220-001
Historical Active 197512-3220-005
RRB
STATEMENTS OF DEATH AND BURIAL EXPENSES BY FUNERAL DIRECTOR
Extension without change of a currently approved collection   No
Regular
Approved without change 11/18/1976
Retrieve Notice of Action (NOA) 11/09/1976
  Inventory as of this Action Requested Previously Approved
01/31/1981 01/31/1981 12/31/1976
27,000 0 27,000
3,500 0 3,500
0 0 0

THE RAILROAD RETIREMENT ACT PROVIDES FOR PAYMENT OF BENEFITS TO QUALIFIED INDIVIDUALS DUE TO DEATH OF A RAILROAD WORKER. THE STATEMENT WILL OBTAIN INFORMATION NEEDED TO SUPPORT A CLAIM FOR THE DEATH BENEFITS.

None
None


No

1
IC Title Form No. Form Name
STATEMENTS OF DEATH AND BURIAL EXPENSES BY FUNERAL DIRECTOR G-273A, G-273

  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 27,000 27,000 0 0 0 0
Annual Time Burden (Hours) 3,500 3,500 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.
11/09/1976


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