REQUEST FOR EMPLOYMENT REPORT IN CONNECTION WITH A CLAIM FOR DISABILITY INSURANCE BENEFITS

ICR 198608-2900-067

OMB: 2900-0129

Federal Form Document

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Status
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IC Document Collections
ICR Details
2900-0129 198608-2900-067
Historical Active 198608-2900-005
VA
REQUEST FOR EMPLOYMENT REPORT IN CONNECTION WITH A CLAIM FOR DISABILITY INSURANCE BENEFITS
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
10/31/1986 10/31/1986 10/31/1986
8,198 0 8,400
2,050 0 2,100
0 0 0

THIS FORM IS USED BY AN NSLI OR USGLI POLICYHOLDER TO PROVIDE EMPLOYMENT INFORMATION IN CONNECTION WITH A CLAIM FOR DISABILITY INSURANCE BENEFITS.

None
None


No

1
IC Title Form No. Form Name
REQUEST FOR EMPLOYMENT REPORT IN CONNECTION WITH A CLAIM FOR DISABILITY INSURANCE BENEFITS 29-30A

  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 8,198 8,400 0 0 -202 0
Annual Time Burden (Hours) 2,050 2,100 0 0 -50 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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