APPLICATION FOR DEATH BENEFITS (FERS), SURVIVOR SUPPLEMENT (FERS), AND DOCUMENTATION OF ELECTIONS IN SUPPORT OF APPLICATION FOR DEATH BENEFITS WHEN DECEASED WAS AN ...
ICR 199406-3206-010
OMB: 3206-0172
Federal Form Document
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 3206-0172 can be found here:
APPLICATION FOR DEATH
BENEFITS (FERS), SURVIVOR SUPPLEMENT (FERS), AND DOCUMENTATION OF
ELECTIONS IN SUPPORT OF APPLICATION FOR DEATH BENEFITS WHEN
DECEASED WAS AN ...
For OPM's
consideration, OMB has provided under seperate cover a number of
minor suggestions for changes to increase clarity. OPM should
provide to OMB a new version of this form indicating those changes
it has adopted.
Inventory as of this Action
Requested
Previously Approved
06/30/1997
06/30/1997
06/30/1994
6,312
0
3,926
6,312
0
3,926
0
0
0
THIS DATA IS NEEDED IN ORDER FOR THE
OFFICE OF PERSONNEL MANAGEMENT TO DETERMINE WHETHER DEATH BENEFITS
SHOULD BE PAID, TO WHOM, AND IN WHAT AMOUNT.
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.