Information Collection

Supplemental Statement In Support Of An Application For Relief On Account Of Loss, Theft Or Destruction Of United States Savings And Retirement Securities

IC 127652 under ICR 198304-1535-014 · OMB 1535-0054.

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Information Collection (IC) Details

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IC Title:	SUPPLEMENTAL STATEMENT IN SUPPORT OF AN APPLICATION FOR RELIEF ON ACCOUNT OF LOSS, THEFT OR DESTRUCTION OF UNITED STATES SAVINGS AND RETIREMENT SECURITIES	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	PD 1048-1				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25,000	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
Annual Number of Responses for this IC	25,000	25,000
Annual IC Time Burden (Hours)	2,075	2,075
Annual IC Cost Burden (Dollars)	0	0

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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.