Information Collection

Application And Claim For Ruia Benefits Unpaid At Death

IC 177022 under ICR 198512-3220-002 · OMB 3220-0055.

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Documents and Forms

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Information Collection (IC) Details

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IC Title:	APPLICATION AND CLAIM FOR RUIA BENEFITS UNPAID AT DEATH	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.	Available Electronically?	Can Be Submitted Electronically?
Form	UI-63	No	No
Form	SI-62	No	No
Form	ID-28(A)(1)	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,625	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	3,625	3,625
Annual IC Time Burden (Hours)	572	572
Annual IC Cost Burden (Dollars)	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.