Information Collection

Application To Elect Reduced Annuity With Survivor Benefit For A Former Spouse, Ri 20-41 (formerly Bri46-423)

IC 157000 under ICR 198610-3206-001 · OMB 3206-0163.

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Document Name	Document Type

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IC Title:

APPLICATION TO ELECT REDUCED ANNUITY WITH SURVIVOR BENEFIT FOR A FORMER SPOUSE, RI 20-41 (FORMERLY BRI46-423)

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	BRI 46-423				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	125	125
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.