APPLICATION FOR IMMEDIATE OR PROSPECTIVE SURVIVOR ANNUITY BENEFITS

ICR 198507-3206-001

OMB: 3206-0159

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
3206-0159 198507-3206-001
Historical Active
OPM
APPLICATION FOR IMMEDIATE OR PROSPECTIVE SURVIVOR ANNUITY BENEFITS
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 07/18/1985
Retrieve Notice of Action (NOA) 07/17/1985
  Inventory as of this Action Requested Previously Approved
10/31/1985 10/31/1985
750 0 0
188 0 0
0 0 0

THIS FORM WILL BE USED BY CERTAIN FORMER SPOUSES OF DECEASED ANNUITANT OR EMPLOYEES TO APPLY FOR SURVIVOR ANNUITY. THIS FORM APPLIES THE RETROACTIVE PROVISIONS OF THE SPOUSE EQUITY ACT (P.L. 98-615) TO PROSPECTIVE APPLICANTS WHO MUST MEET SIX CRITERIA OF THE ACT.

None
None


No

1
IC Title Form No. Form Name
APPLICATION FOR IMMEDIATE OR PROSPECTIVE SURVIVOR ANNUITY BENEFITS BRI 46-424

  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 750 0 0 750 0 0
Annual Time Burden (Hours) 188 0 0 188 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
07/17/1985


© 2024 OMB.report | Privacy Policy