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Registration/Eligibility Form and Application for Emergency Benefits from the Victim Compensation Fund

IC 11762 under ICR 200206-1105-001 · OMB 1105-0073.

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Registration/Eligibility Form and Application for Emergency Benefits from the Victim Compensation Fund
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SM-001 Yes Yes


    

5,000 0
   
Individuals or Households
 
   50 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 5,000 0 0 0 0 5,000
Annual IC Time Burden (Hours) 30,000 0 0 0 0 30,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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