Information Collection Request

Death Gratuity

ICR 200908-1215-001 · OMB 1215-0206 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form ca-42 Death Gratuity Official Notice of Employees' Death Form and Instruction New Available
Form ca-41 Death Gratuity Claim for Survivor Benefits Form and Instruction New Available
Form ca-40 Death Gratuity Beneficiary Designation Form and Instruction New Available
DEPARTMENT OF LABOR 1215-AB66 Emergency Submission.doc Supplementary Document Uploaded 2009-08-27 Available
dol-govt-1.doc Supplementary Document Uploaded 2009-08-10 Available
2009 opm salary table (4).pdf Supplementary Document Uploaded 2009-08-10 Available
2009 databases tables and calculators by subject 8-10-09.pdf Supplementary Document Uploaded 2009-08-10 Available
Death Gratuity Forms Supporting Statement 8-27-2009.doc Supporting Statement A Uploaded 2009-08-28 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
190297 Death Gratuity Official Notice of Employees' Death Form and Instruction New
190296 Death Gratuity Claim for Survivor Benefits Form and Instruction New
190277 Death Gratuity Beneficiary Designation Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
05/31/2010 6 Months From Approved
2,635 0 0
659 0 0
12 0 0





table that charts list of burden
  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 2,635 0 2,635 0 0 0
Annual Time Burden (Hours) 659 0 659 0 0 0
Annual Cost Burden (Dollars) 12 0 12 0 0 0


Reginfo record details
  No