Claim Documentation Form Administrative

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSS FORM 21 Claim Documentation Form - Administrative	Form and Instruction	Modified	Available
SSS FORM 21 SUPPORTING STATEMENT.pdf	Supporting Statement B	Uploaded 2008-07-24	Available
SSS FORM 21.pdf	Supporting Statement A	Uploaded 2008-07-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
35534	Claim Documentation Form Administrative	Form and Instruction	Modified	Claim Documentation Form - Administrative

ICR Details

OMB Control No: 3240-0025	ICR Reference No: 200807-3240-003
Status: Historical Inactive	Previous ICR Reference No: 200506-3240-009
Agency/Subagency: SSS	Agency Tracking No:
Title: Claim Documentation Form Administrative
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn	Conclusion Date: 08/19/2008
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/24/2008
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved	12/31/2008
Responses	0	0	1
Time Burden (Hours)	0	0	1
Cost Burden (Dollars)	0	0	0

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Abstract: This form is available to all Selective Service registrants for use in documenting claims for Administrative Classifications 1-C, 1-0-S, 1-D-D, 1-D-E, 3-A-S (based on separation from military service), 4-A, 4-A-A, 4-B, 4-F, 4-G. These are claims which can be approved by Area Offices upon presentation of documentary proof.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 143	07/24/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 143	07/24/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Claim Documentation Form Administrative	SSS FORM 21	Claim Documentation Form - Administrative

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Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 07/24/2008

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