Information Collection

State Death Match - Manual - Non-EDR sites

IC 227857 under ICR 201705-0960-006 · OMB 0960-0700.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0700 can be found here:

Documents and Forms

Document Name Document Type
Instructions and File Format for States' Use.docx Instruction
DFSTATE Format.docx Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State Death Match - Manual - Non-EDR sites	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.371 20 CFR 404.310-311 20 CFR 404.350-352 20 CFR 404.316 20 CFR 404.330-341 20 CFR 416.912 20 CFR 404.301

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Instructions and File Format for States' Use.docx		No		Paper Only
Instruction			DFSTATE Format.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: 12	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	576,000	576,000
Annual IC Time Burden (Hours)	0	0
Annual IC Cost Burden (Dollars)	506,880	506,880

Documents for IC

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.