Information Collection

Funeral Director's Statement of Burial Charges

IC 189282 under ICR 202204-3220-002 · OMB 3220-0031.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form G-273a (06-19) Funeral Director's Statement of Burial Charges	Form and Instruction
G-273a (06-19) Funeral Director's Statement of Burial Charges Form G-273a (06-19).pdf	Form and Instruction
G-273a (06-19) Funeral Director's Statement of Burial Charges Form G-273a (06-19).pdf	Form and Instruction
G-273A (Proposed) Funeral Director's Statement of Burial Expenses Form G-273A (xx-xx) - Proposed.pdf	Form
G-273A (Proposed) Funeral Director's Statement of Burial Expenses Form G-273A (xx-xx) - Proposed.pdf	Form

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 219.58 20 CFR 219.59

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
Form and Instruction	G-273a (06-19)	Funeral Director's Statement of Burial Charges	Form G-273a (06-19).pdf		No		Paper Only
Form	G-273A (Proposed)	Funeral Director's Statement of Burial Expenses	Form G-273A (xx-xx) - 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 %

table that charts list of burden
	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

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.