Information Collection

September 11th Victim Compensation Registration Form

IC 199461 under ICR 201110-1123-001 · OMB 1123-0012.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Screen Shots 09262011.doc	Other-Screen Shots
OMB Number 1123-00 Deceased Compensation Form Deceased Compensation Form - unformatted_102811.doc	Form and Instruction
OMB Number 1123-00 Deceased Eligibility Form Deceased Eligibility Form 10282011 939PM.PDF	Form and Instruction
OMB Number 1123-00 PI Compensation Form PI Compensation Form - unformatted.doc	Form and Instruction
OMB Number 1123-00 PI Eligibility Form Final PI Eligibility Form FINAL 10272011 907PM.PDF	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screen Shots			Screen Shots 09262011.doc	Yes	Yes	Fillable Fileable
Form and Instruction	OMB Number 1123-0012	Deceased Compensation Form	Deceased Compensation Form - unformatted_102811.doc	Yes	Yes	Fillable Fileable
Form and Instruction	OMB Number 1123-0012	Deceased Eligibility Form	Deceased Eligibility Form 10282011 939PM.PDF	Yes	Yes	Fillable Fileable
Form and Instruction	OMB Number 1123-0012	PI Compensation Form	PI Compensation Form - unformatted.doc	Yes	Yes	Fillable Fileable
Form and Instruction	OMB Number 1123-0012	PI Eligibility Form Final	PI Eligibility Form FINAL 10272011 907PM.PDF	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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	70,000	0	70,000
Annual IC Time Burden (Hours)	700,000	676,900	23,100
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.