September 11th Victim Compensation Registration Form

September 11th Victim Compensation Fund Claimant Registration Form

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1123-0012 can be found here:

Documents and Forms

Document Name Document Type
Screen Shots 09262011.doc Other-Screen Shots

Information Collection (IC) Details

IC Title:	September 11th Victim Compensation Registration Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screen Shots			Screen Shots 09262011.doc		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 70,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	70,000	70,000
Annual IC Time Burden (Hours)	23,100	23,100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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