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 169748 under ICR 198409-1535-012 · 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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	PD 1048-1				No	No

Federal Enterprise Architecture Business Reference Module

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 %

table that charts list of burden
	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

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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.

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