Information Collection

Beneficiary Designation (Exchange Form 1700-012)

IC 222966 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form Exchange Form 1700 Beneficiary Designation (Exchange Form 1700-012) Form and Instruction
Exchange Form 1700 Beneficiary Designation EXCHANGE FORM 1700-012 - BENEFICIARY DESIGNATION.pdf Form and Instruction
Exchange Form 1700 Beneficiary Designation EXCHANGE FORM 1700-012 - BENEFICIARY DESIGNATION.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Beneficiary Designation (Exchange Form 1700-012)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Exchange Form 1700-012	Beneficiary Designation	EXCHANGE FORM 1700-012 - BENEFICIARY DESIGNATION.pdf		Yes	Yes	Fillable Printable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 250	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	250	0	250
Annual IC Time Burden (Hours)	83	0	83
Annual IC Cost Burden (Dollars)	2,909	659	2,250

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.