Information Collection

Application For Grant Of An Annuity Pursuant To Section 523 (c) P.l.94-350, Approved 7/12/76

IC 124169 under ICR 197807-1405-004 · OMB 1405-0024.

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IC Title:

APPLICATION FOR GRANT OF AN ANNUITY PURSUANT TO SECTION 523 (C) P.L.94-350, APPROVED 7/12/76

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DSP-91				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	10	-60	70
Annual IC Time Burden (Hours)	3	-17	20
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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Title	Document	Date Uploaded

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