Information Collection

State Death Match - Manual - Non-EDR Records from EDR sites

IC 9754 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Instructions and File Format for States' Use.docx	Instruction
DFSTATE Format.docx	Instruction

IC Title:

State Death Match - Manual - Non-EDR Records from EDR sites

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.301 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

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
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: 45

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	166,500	-283,500	450,000
Annual IC Time Burden (Hours)	0	0	0
Annual IC Cost Burden (Dollars)	146,520	-231,480	378,000

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.