Information Collection

Application For Lump-sum Death Payment And Annuities Unpaid

IC 157335 under ICR 198011-3220-001 · OMB 3220-0031.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0031 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	APPLICATION FOR LUMP-SUM DEATH PAYMENT AND ANNUITIES UNPAID	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-21				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 18,000	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	18,000	3,000	15,000
Annual IC Time Burden (Hours)	9,000	1,500	7,500
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.