Application for Death Benefits (FERS)/Documentation and Elections in Support of Application for Death Benefits when Deceased was an Employee at the Time of Death (FERS)

ICR 202211-3206-003

OMB: 3206-0172

Federal Form Document

Forms and Documents

Document Name	Status
Form Standard Form 3104 Application for Death Benefits (FERS); Documentation and Elections in Support of Application for Death Benefits when Deceased was an Employee at the Time of Death Form and Instruction	Modified
SF3104_OMB_Supporting_Stmt_2022_4_19.docx Supporting Statement A	2022-11-15
FACES 2017 FINAL 12212017signed.pdf Supplementary Document	2022-11-15
ARS PIA Final 12212017signed.pdf Supplementary Document	2022-11-15
SF3104_30DayFRNPublished_2022_08_24.PDF Supplementary Document	2022-11-15
SF3104_60DAYFRN_Published_2022_02_18.pdf Supplementary Document	2022-11-15

IC Document Collections

IC ID	Document Title	Status
33651	Application for Death Benefits (FERS); Documentation and Elections in Support of Application for Death Benefits when Deceased was an Employee at the Time of Death Form and Instruction	Modified