Information Collection

20 CFR 429.102; 429.103 - Filing a Claim (SF-95, OMB No. 1105-0008)

IC 9718 under ICR 202104-0960-001 · OMB 0960-0667.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0667 can be found here:

Documents and Forms

Document Name Document Type
SF-95.pdf SF-95 Claim for Damage, Injury, or Death IC Document
SF-95.pdf SF-95 Claim for Damage, Injury, or Death IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	20 CFR 429.102; 429.103 - Filing a Claim (SF-95, OMB No. 1105-0008)	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 429.103 20 CFR 429.102

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SF-95 Claim for Damage, Injury, or Death	SF-95.pdf	06/11/2021

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