Information Collection

Participant Benefit Application Survey

IC 219507 under ICR 201406-1212-015 · OMB 1212-0066.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0066 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
BAPD Participant Benefit Application Survey - Email message.docx	Instruction
Participant Benefit Application Survey 1-2016.docx	Other-Survey
Generic Clearance Submission for Benefit Application Survey 1-2016.docx Generic Clearance Submission for Participant Benefit Application Survey	IC Document

IC Title:

Participant Benefit Application Survey

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			BAPD Participant Benefit Application Survey - Email message.docx		Yes	No	Printable Only
Other-Survey			Participant Benefit Application Survey 1-2016.docx		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 250

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	63	63
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Clearance Submission for Participant Benefit Application Survey	Generic Clearance Submission for Benefit Application Survey 1-2016.docx	01/06/2016

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