Application for disposition of Retirement Plan/Individual Retirement Bonds Without Admin. of Deceased Owners Estate

Forms and Documents

Document Name	Status
Form PD F 3565 Application for disposition of Retirement Plan/Individual Retirement Bonds Without Admin. of Deceased Owners Estate Form and Instruction	Modified
Supporting Statement_3565.docx Supporting Statement A	2012-06-29

IC Document Collections

IC ID	Document Title	Status
16523	Application for disposition of Retirement Plan/Individual Retirement Bonds Without Admin. of Deceased Owners Estate Form and Instruction	Modified

ICR Details

OMB Control No: 1530-0032	ICR Reference No: 201407-1530-034
Status: Historical Active	Previous ICR Reference No: 200904-1535-002
Agency/Subagency: TREAS/FISCAL	Agency Tracking No:
Title: Application for disposition of Retirement Plan/Individual Retirement Bonds Without Admin. of Deceased Owners Estate
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/31/2014
	Date Received in OIRA: 07/31/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2015	36 Months From Approved
Responses	350	0	50
Time Burden (Hours)	117	0	17
Cost Burden (Dollars)	0	0	0

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Abstract: Used by heirs of deceased owners of Retirement Plan and/or Individual Retirement Bonds to request disposition.

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Authorizing Statute(s): US Code: 31 USC 31 Name of Law: null
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 19424	03/30/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 40702	07/10/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Application for disposition of Retirement Plan/Individual Retirement Bonds Without Admin. of Deceased Owners Estate	PD F 3565	Application For Disposition Of Retirement Plan And/Or Individual Retirement Bonds Without Administration Of Deceased Owner's Estate

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	350	50	0	0	300	0
Annual Time Burden (Hours)	117	17	0	0	100	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The reported burden increase is due to an examination of forms distributed from our warehouse and downloaded from our website over the past 3-4 years. Previous burden was reported based on estimates of use. The increase of 100 hours is an adjustment in agency estimate for a total of 117 burden hours requested.

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Annual Cost to Federal Government: $1,032

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/24/2012

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