Information Collection

Next of Kin

IC 188610 under ICR 201306-0925-001 · OMB 0925-0414.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0414 can be found here:

Documents and Forms

Document Name Document Type
Form 23 Next of Kin Form and Instruction
23 Search to Locate Participants F23V8.2.pdf Form and Instruction
120 Initial Notification of Death F120V8.1.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Next of Kin	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	23	Search to Locate Participants	F23V8.2.pdf		No	No	Paper Only
Form and Instruction	120	Initial Notification of Death	F120V8.1.pdf		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 936	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	936	-5	941
Annual IC Time Burden (Hours)	94	16	78
Annual IC Cost Burden (Dollars)	0	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.