Information Collection

September 11th Victim Compensation Registration Form

IC 199461 under ICR 201201-1105-003 · OMB 1105-0092.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1105-0092 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form OMB Number 1123-00 Deceased Compensation Form September 11th Victim Compensation Registration Form	Form and Instruction
Form OMB Number 1123-00 Deceased Eligibility Form September 11th Victim Compensation Registration Form	Form and Instruction
Form OMB Number 1123-00 PI Compensation Form September 11th Victim Compensation Registration Form	Form and Instruction
Form OMB Number 1123-00 PI Eligibility Form Final September 11th Victim Compensation Registration Form	Form and Instruction
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:

September 11th Victim Compensation Registration Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screen Shots		Yes	Yes	Fillable Fileable
Form and Instruction	OMB Number 1123-0012	Yes	Yes	Fillable Fileable
Form and Instruction	OMB Number 1123-0012	Yes	Yes	Fillable Fileable
Form and Instruction	OMB Number 1123-0012	Yes	Yes	Fillable Fileable
Form and Instruction	OMB Number 1123-0012	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
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-70,000	70,000
Annual IC Time Burden (Hours)	-700,000	700,000
Annual IC Cost Burden (Dollars)	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.

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