SUPPLEMENT TO APPLICATION FOR WIDOW(ER)'S INSURANCE ANNUITY

ICR 197803-3220-002

OMB: 3220-0094

Federal Form Document

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Document
Name
Status
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IC Document Collections
ICR Details
3220-0094 197803-3220-002
Historical Active 197803-3220-001
RRB
SUPPLEMENT TO APPLICATION FOR WIDOW(ER)'S INSURANCE ANNUITY
Extension without change of a currently approved collection   No
Regular
Approved without change 04/24/1978
Retrieve Notice of Action (NOA) 03/31/1978
  Inventory as of this Action Requested Previously Approved
04/30/1979 04/30/1979 07/31/1978
2,400 0 2,400
400 0 400
0 0 0



None
None


No

1
IC Title Form No. Form Name
SUPPLEMENT TO APPLICATION FOR WIDOW(ER)'S INSURANCE ANNUITY AA-17B

  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 2,400 2,400 0 0 0 0
Annual Time Burden (Hours) 400 400 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.
03/31/1978


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