Evidence to Prove Dependency of a Child

ICR 199412-3206-003

OMB: 3206-0206

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
157114 Migrated
ICR Details
3206-0206 199412-3206-003
Historical Active 199202-3206-004
OPM
Evidence to Prove Dependency of a Child
Extension without change of a currently approved collection   No
Regular
Approved without change 03/29/1995
Retrieve Notice of Action (NOA) 12/29/1994
  Inventory as of this Action Requested Previously Approved
01/31/1998 01/31/1998 03/31/1995
250 0 0
250 0 250
0 0 0

RI 25-37 is designed to collect sufficient information for the Retirement and Insurance Group to be able to determine whether the surviving child of a deceased Federal employee is eligible to receive benefits as a dependent child.

None
None


No

1
IC Title Form No. Form Name
Evidence to Prove Dependency of a Child 25-37

  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 250 0 0 250 0 0
Annual Time Burden (Hours) 250 250 0 0 0 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.
12/29/1994


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