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

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
3206-0172 199406-3206-010
Historical Active 199110-3206-004
OPM
APPLICATION FOR DEATH BENEFITS (FERS), SURVIVOR SUPPLEMENT (FERS), AND DOCUMENTATION OF ELECTIONS IN SUPPORT OF APPLICATION FOR DEATH BENEFITS WHEN DECEASED WAS AN ...
Revision of a currently approved collection   No
Regular
Approved without change 09/20/1994
Retrieve Notice of Action (NOA) 06/30/1994
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.

None
None


No

  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 6,312 3,926 0 0 2,386 0
Annual Time Burden (Hours) 6,312 3,926 0 0 2,386 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.
06/30/1994


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