APPLICATION FOR DEATH BENEFITS UNDER CIVIL SERVICE RETIREMENT SYSTEM

ICR 199102-3206-003

OMB: 3206-0156

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
3206-0156 199102-3206-003
Historical Active 198812-3206-002
OPM
APPLICATION FOR DEATH BENEFITS UNDER CIVIL SERVICE RETIREMENT SYSTEM
Revision of a currently approved collection   No
Regular
Approved without change 04/25/1991
Retrieve Notice of Action (NOA) 02/22/1991
This request, as amended by the amended material sent to Joe Lackey of OMB on 4-11-91, is approved. Additionally, as agreed to by Doris Benz of OPM on 4-24-91, references to "clergyman" in item B7 and its instructions will be changed to "clergy."
  Inventory as of this Action Requested Previously Approved
04/30/1994 04/30/1994 12/31/1991
70,000 0 57,000
35,000 0 28,500
0 0 0

THE INFORMATION COLLECTED VIA SF 2800 IS USED TO DETERMINE WHETHER A BENEFIT IS PAYABLE UNDER THE CIVIL SERVICE RETIREMENT SYSTEM IN THE EVENT OF THE DEATH OF AN EMPLOYEE, FORMER EMPLOYEE, OR AN ANNUITANT.

None
None


No

1
IC Title Form No. Form Name
APPLICATION FOR DEATH BENEFITS UNDER CIVIL SERVICE RETIREMENT SYSTEM SF 2800

  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 70,000 57,000 0 0 13,000 0
Annual Time Burden (Hours) 35,000 28,500 0 0 6,500 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.
02/22/1991


© 2024 OMB.report | Privacy Policy