Information Collection

Application (medical) For Reinstatement-life Insurance/disability Income Prov.

IC 174026 under ICR 198011-2900-011 · OMB 2900-0011.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0011 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	APPLICATION (MEDICAL) FOR REINSTATEMENT-LIFE INSURANCE/DISABILITY INCOME PROV.	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	29-352				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	975	-1,325	2,300
Annual IC Time Burden (Hours)	1,462	-1,988	3,450
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.