This request, as
amended by the changed page submitted by Ron Trueworthy of OPM
showing the burden disclosure notice, is approved. It is understood
that the notice will be included in the next printing of the
form.
Inventory as of this Action
Requested
Previously Approved
07/31/1993
07/31/1993
07/31/1990
1,560
0
1,560
780
0
780
0
0
0
THE SF 3104 FORM IS USED TO APPLY FOR
SURVIVOR BENEFITS UNDER THE FEDERAL EMPLOYEES' RETIREMENT SYSTEM.
IT IS COMPLETED BY SURVIVORS OF CIVIL ANNUITANTS, DECEASED FEDERAL
EMPLOYEES OR DECEASED FORMER FEDERAL EMPLOYEES.
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.