CLAIM FOR ONE SUM PAYMENT

ICR 198608-2900-025

OMB: 2900-0060

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
174163 Migrated
ICR Details
2900-0060 198608-2900-025
Historical Active 198312-2900-025
VA
CLAIM FOR ONE SUM PAYMENT
No material or nonsubstantive change to a currently approved collection   No
Emergency 08/08/1986
Approved with change 08/08/1986
Retrieve Notice of Action (NOA) 08/08/1986
  Inventory as of this Action Requested Previously Approved
02/28/1987 02/28/1987 02/28/1987
85,596 0 80,665
14,266 0 13,713
0 0 0

THIS FORM IS USED BY CLAIMANTS APPLYING FOR THE PROCEEDS OF GOVT. LIFE INSURANCE POLICIES. THE INFO. COLLECTED IS REQUIRED TO DETERMINE ELIGIBILITY OF THE CLAIMANT TO RECEIVE PAYMENT OF THE PROCEEDS.

None
None


No

1
IC Title Form No. Form Name
CLAIM FOR ONE SUM PAYMENT 29-4125

  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 85,596 80,665 0 0 4,931 0
Annual Time Burden (Hours) 14,266 13,713 0 0 553 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.
08/08/1986


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