Information Collection

Claims For Compensation By Dependents And Dependents Information Reports (death)

IC 122312 under ICR 198901-1215-002 · OMB 1215-0155.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1215-0155 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	CLAIMS FOR COMPENSATION BY DEPENDENTS AND DEPENDENTS INFORMATION REPORTS (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	CA-5, 5B,	No	No
Form	1615, 1617,	No	No
Form	1085, 1074,	No	No
Form	1031, 1072	No	No
Form	1093	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,615	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,615	-150	3,765
Annual IC Time Burden (Hours)	1,835	-262	2,097
Annual IC Cost Burden (Dollars)	0	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.