Information Collection

State Death Match - States Expected to Become EDR's within next 3 Year

IC 256495 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⚠️ Notice: This information collection may be referencing outdated material.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
Death Screen Images.pdf	Other-Death Screen Images
Death Screen Images.pdf	Other-Death Screen Images

IC Title:

State Death Match - States Expected to Become EDR's within next 3 Year

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-Death Screen Images			Death Screen Images.pdf		Yes	Yes	Fillable Fileable

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	313,000	313,000
Annual IC Time Burden (Hours)	0	0
Annual IC Cost Burden (Dollars)	992,210	992,210

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.