THE APPROVAL OF
THIS FORM THROUGH NOVEMBER 1986 IS CONDITIONAL. IT REQUIRES THAT
THE OMB NUMBER AND THE NATURE OF THE COLLECTION IN ACCORDANCE WITH
5 CFR 1320.12(D) AND 1320.18(B) BE DISPLAYED ON THE FORM BY MARCH
31, 1984. THE EXISTING SUPPLY OF FORMS MAY BE USED BY ATTACHING A
SHEET WITH THIS ADDITIONAL INFORMATION OR BY OTHER APPROPRIATE
MEANS. THE OMB DESK OFFICER IS TO BE INFORMED BY JANUARY 15, 1984
OF STEPS TAKEN TO COMPLY WITH THIS REQUIREMENT.
Inventory as of this Action
Requested
Previously Approved
11/30/1986
11/30/1986
01/31/1984
2,620
0
2,620
525
0
525
0
0
0
FORM LESSENS PAPERWORK OTHERWISE
NECESSARY TO ESTABLISH PREFERRED CREDITOR OF A PERSON, NOW
DECEASED, WHOSE ESTATE IS NOT BEING ADMINISTERED BY A COURT
APPOINTED REPRESENTATIVE. USED BY PERSON OR ORGANIZATION TAKING
CARE OF FUNERAL EXPENSES AND/OR UNPAID BILLS OF DECEDENT.
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.