Information Collection

Application For Widow's Or Widower's Insurance Annuity

IC 157323 under ICR 197711-3220-003 · OMB 3220-0030.

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Documents and Forms

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Information Collection (IC) Details

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IC Title:	APPLICATION FOR WIDOW'S OR WIDOWER'S INSURANCE ANNUITY	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	AA-17				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 19,200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	19,200	9,600	9,600
Annual IC Time Burden (Hours)	4,800	1,600	3,200
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.