Information Collection

Appeal From Initial Decision Of Bureau Of Retirement Claims; Appeal From Decision Of The Referee

IC 157209 under ICR 197909-3220-001 · OMB 3220-0007.

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Documents and Forms

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Document Name	Document Type

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IC Title:

APPEAL FROM INITIAL DECISION OF BUREAU OF RETIREMENT CLAIMS; APPEAL FROM DECISION OF THE REFEREE

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Voluntary

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	AC-1(10-76)				No	No
Form	& AC-2(9-70)				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 560

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	560	260	300
Annual IC Time Burden (Hours)	280	130	150
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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