Information Collection

Claim For Compensation By Dependents Information Reports

IC 122314 under ICR 199501-1215-003 · OMB 1215-0155.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1215-0155 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	CLAIM FOR COMPENSATION BY DEPENDENTS INFORMATION REPORTS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	CA-5/5B	No	No
Form	1031/1074	No	No
Form	1085/1093	No	No
Form	1615/1617	No	No
Form	1618	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,615	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,615	3,615	0
Annual IC Time Burden (Hours)	1,835	0	1,835
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.