Claim For One Sum Payment (life Insurance)

CLAIM FOR ONE SUM PAYMENT (LIFE INSURANCE)

OMB: 2900-0060

IC ID: 174161

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CLAIM FOR ONE SUM PAYMENT (LIFE INSURANCE)
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 29-4125 No No


    

45,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 48,000 0 3,000 0 0 45,000
Annual IC Time Burden (Hours) 8,000 0 500 0 0 7,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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