Funeral Director's Statement of Burial Charges

Application for Survivor Death Benefits

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0031 can be found here:

Documents and Forms

Document Name Document Type
Form G-273a (04-16) Funeral Director's Statement of Burial Charges Form and Instruction
G-273a (04-16) Funeral Director's Statement of Burial Charges Form G-273A (04-16).pdf Form and Instruction
G-273A (Proposed) Funeral Director's Statement of Burial Expenses Form G-273A (Proposed).pdf Form

Information Collection (IC) Details

IC Title:	Funeral Director's Statement of Burial Charges	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 219.59 20 CFR 219.58

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	G-273a (04-16)	Funeral Director's Statement of Burial Charges	Form G-273A (04-16).pdf		No		Paper Only
Form	G-273A (Proposed)	Funeral Director's Statement of Burial Expenses	Form G-273A (Proposed).pdf		No		Paper Only

Line of Business: Income Security

Subfunction: Survivor Compensation

Privacy Act System of Records
Title: RRB-22, Railroad Retirement, Survivor and Pension Benefit System	FR Citation: 79 FR 58874

Number of Respondents: 4,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	4,000	4,000
Annual IC Time Burden (Hours)	667	667
Annual IC Cost Burden (Dollars)	0	0

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.