Application for Death Benefits (FERS)/Documentation and Elections in Support of Application for Death Benefits when Deceased was an Employee at the Time of Death (FERS)

ICR 202203-3206-009

OMB: 3206-0172

Federal Form Document

Forms and Documents
ICR Details
3206-0172 202203-3206-009
Received in OIRA 201909-3206-001
OPM SF 3104/SF 3104B
Application for Death Benefits (FERS)/Documentation and Elections in Support of Application for Death Benefits when Deceased was an Employee at the Time of Death (FERS)
No material or nonsubstantive change to a currently approved collection   No
Regular 03/08/2022
  Requested Previously Approved
11/30/2022 11/30/2022
16,751 16,751
16,751 16,751
225,066 225,066

SF 3104, Application for Death Benefits (FERS), is used by persons applying for death benefits which may be payable under FERS because of the death of an employee, former employee, or retiree who was covered by FERS at the time of his/her death or separation from Federal Service. SF 3104B, Documentation and Elections in Support of Application for Death Benefits when Deceased was an Employee at the Time of Death, is used by applicants for death benefits under FERS if the deceased was a Federal employee at the time of death.

US Code: 5 USC Chapter 84 Name of Law: Federal Employees Retirement System
  
None

Not associated with rulemaking

  83 FR 61176 11/28/2018
84 FR 40440 08/14/2019
No

  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 16,751 16,751 0 0 0 0
Annual Time Burden (Hours) 16,751 16,751 0 0 0 0
Annual Cost Burden (Dollars) 225,066 225,066 0 0 0 0
No
No

$332,675
No
    Yes
    Yes
No
No
No
No
Charles Conyers 202 606-0125 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
03/08/2022


© 2024 OMB.report | Privacy Policy