U.s. Victims Of State Sponsored Terrorism Fund

NON-SUBSTANTIVE CHANGE REQUEST

U.S. VICTIMS OF STATE SPONSORED TERRORISM FUND

OMB CONTROL NUMBER 1123-0013

The U.S. Victims of State Sponsored Terrorism Fund (“USVSST Fund”) submits this non-substantive change request to collection 1123-0013 (United States Victims of State Sponsored Terrorism Application Form) (“Application”). Part V of the USVSST Fund’s Application, titled NOTICE TO INDIVIDUALS OF FILING OF CLAIM, specifically references a notice of claim for use by those applicants filing claims on behalf of deceased individuals and states that “[t]he ‘Additional Forms’ page of the Fund website contains the notice [the Personal Representative] must provide to the required individuals.” This notice of filing claim is required under Part VII.2.a of the USVSST Fund Notice published in the Federal Register, which requires that “[a]ny purported Personal Representative must, before filing a claim, provide written notice of the claim to the immediate family of the decedent; to the executor, administrator, and beneficiaries of the decedent’s will; and to any other persons who may reasonably be expected to assert an interest in an award or to have a cause of action to recover damages relating to the wrongful death of the decedent.” The USVSST Fund inadvertently did not, however, include the notice of filing claim for review and approval by the Office of Management and Budget (OMB) as part of its emergency collection request. Accordingly, the USVSST Fund submits this change request to clarify the already approved collection. The only aspect of the notice of filing claim that will effect a change in the information collection is the inclusion of a drafted sample notice of filing claim for use by those applicants filing an Application on behalf of a deceased individual.

Additional annual burden: 1,200 x 10 mins = 200 hours