Information Collection

State Death Match - Manual - Non-EDR

IC 256493 under ICR 202210-0960-006 · OMB 0960-0142.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0142 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instructions and File Format for States' Use.docx	Other-Instructions and File Format f
Instructions and File Format for States' Use.docx	Other-Instructions and File Format f

IC Title:

State Death Match - Manual - Non-EDR

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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
Other-Instructions and File Format for State's Use			Instructions and File Format for States' Use.docx		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	937,850	937,850
Annual IC Time Burden (Hours)	0	0
Annual IC Cost Burden (Dollars)	825,308	825,308

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.