APPLICATION AND CLAIM FOR RUIA BENEFITS UNPAID AT DEATH

ICR 198411-3220-002

OMB: 3220-0055

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
177021 Migrated
ICR Details
3220-0055 198411-3220-002
Historical Active 198409-3220-002
RRB
APPLICATION AND CLAIM FOR RUIA BENEFITS UNPAID AT DEATH
No material or nonsubstantive change to a currently approved collection   No
Emergency 11/13/1984
Approved with change 11/13/1984
Retrieve Notice of Action (NOA) 11/13/1984
  Inventory as of this Action Requested Previously Approved
10/31/1987 10/31/1987 10/31/1987
3,625 0 3,625
572 0 572
0 0 0

THE COLLECTION OBTAINS THE INFORMATION NEEDED BY THE BOARD TO PAY, UNDER SECTION 2(G) OF THE RUIA, BENEFITS UNDER THAT ACT ACCRUED BUT NO PAID BECAUSE OF THE DEATH OF THE EMPLOYEE.

None
None


No

1
IC Title Form No. Form Name
APPLICATION AND CLAIM FOR RUIA BENEFITS UNPAID AT DEATH ID, 38(A)(1), SI-62, 11I-63

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 3,625 3,625 0 0 0 0
Annual Time Burden (Hours) 572 572 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

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.
11/13/1984


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