Report of Public Safety Officers' Death

Report of Public Safety Officers' Death

OMB: 1121-0025

IC ID: 12366

Information Collection (IC) Details

View Information Collection (IC)

Report of Public Safety Officers' Death BJA
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 3650/6 Report of Public safety Officer's Death REPORT OF DEATH FORM.pdf www.psob.gov Yes Yes Fillable Fileable

Income Security Survivor Compensation

 

275 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 275 0 -45 0 320 0
Annual IC Time Burden (Hours) 550 0 -250 0 800 0
Annual IC Cost Burden (Dollars) 2,578 0 -422 0 3,000 0

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

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