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

SUPPLEMENTAL STATEMENT IN SUPPORT OF AN APPLICATION FOR RELIEF ON ACCOUNT OF LOSS, THEFT OR DESTRUCTION OF UNITED STATES SAVINGS AND RETIREMENT SECURITIES

Documents and Forms

Document Name Document Type

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Information Collection (IC) Details

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: 12,000	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	12,000	0	12,000
Annual IC Time Burden (Hours)	1,008	-192	1,200
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.