Information Collection

Annuity Application (Exchange Form 1450-011)

IC 222963 under ICR 202209-0702-002 · OMB 0702-0139.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0702-0139 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Exchange Form 1450 Annuity Application (Exchange Form 1450-011)	Form and Instruction
Exchange Form 1450 Annuity Application EXCHANGE FORM 1450-011 - ANNUITY APPLICATION.pdf	Form and Instruction
Exchange Form 1450 Annuity Application EXCHANGE FORM 1450-011 - ANNUITY APPLICATION.pdf	Form and Instruction

IC Title:

Annuity Application (Exchange Form 1450-011)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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	Exchange Form 1450-011	Annuity Application	EXCHANGE FORM 1450-011 - ANNUITY APPLICATION.pdf		Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 320

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	320	0	320
Annual IC Time Burden (Hours)	107	27	80
Annual IC Cost Burden (Dollars)	3,724	1,564	2,160

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.