Information Collection

Modified Benefit Formula Questionnaire – Foreign Pension Class Members

IC 213556 under ICR 201501-0960-014 · OMB 0960-0561.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0561 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Draft Form To Request Settlement Claim Review v2.DOCX	Other-Telephone interview

IC Title:

Modified Benefit Formula Questionnaire â Foreign Pension Class Members

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Telephone interview			Draft Form To Request Settlement Claim Review v2.DOCX		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,666

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,666	1,666
Annual IC Time Burden (Hours)	1,666	1,666
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.