Claim for Unpaid Compensation of Deceased Civilian Employee

ICR 200506-3206-001

OMB: 3206-0234

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
3206-0234 200506-3206-001
Historical Active 200110-3206-002
OPM
Claim for Unpaid Compensation of Deceased Civilian Employee
Revision of a currently approved collection   No
Regular
Approved without change 07/14/2005
Retrieve Notice of Action (NOA) 06/03/2005
  Inventory as of this Action Requested Previously Approved
07/31/2008 07/31/2008 07/31/2005
3,000 0 3,000
750 0 750
0 0 0

Information from claimant to assist OPM in processing claims

None
None


No

1
IC Title Form No. Form Name
Claim for Unpaid Compensation of Deceased Civilian Employee SF-1153

  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 3,000 3,000 0 0 0 0
Annual Time Burden (Hours) 750 750 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.
06/03/2005


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