Eligibility Questionnaire For Havana Act Payments

Eligibility Questionnaire for HAVANA Act Payments

Documents and Forms

Document Name Document Type
Form CD-350 ELIGIBILITY QUESTIONNAIRE FOR HAVANA ACT PAYMENTS Form and Instruction
RELATIONSHIP DOCS - HAVANA Act Payments Collection.docx Instruction
RELATIONSHIP DOCS - HAVANA Act Payments Collection.docx Instruction
CD-350 ELIGIBILITY QUESTIONNAIRE FOR HAVANA ACT PAYMENTS FINAL CD-350 Eligibility Questionnaire for HAVANA Act Payments.pdf Form and Instruction
CD-350 ELIGIBILITY QUESTIONNAIRE FOR HAVANA ACT PAYMENTS FINAL CD-350 Eligibility Questionnaire for HAVANA Act Payments.pdf Form and Instruction
CD-350 ELIGIBILITY QUESTIONNAIRE FOR HAVANA ACT PAYMENTS Fax Nu CD-350 FINAL 508 Compliant 7.13.23.pdf Form
CD-350 ELIGIBILITY QUESTIONNAIRE FOR HAVANA ACT PAYMENTS Fax Nu CD-350 FINAL 508 Compliant 7.13.23.pdf Form

Information Collection (IC) Details

IC Title:	ELIGIBILITY QUESTIONNAIRE FOR HAVANA ACT PAYMENTS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CD-350	ELIGIBILITY QUESTIONNAIRE FOR HAVANA ACT PAYMENTS	FINAL CD-350 Eligibility Questionnaire for HAVANA Act Payments.pdf	No		Fillable Printable
Instruction			RELATIONSHIP DOCS - HAVANA Act Payments Collection.docx	Yes	Yes	Fillable Printable
Form	CD-350	ELIGIBILITY QUESTIONNAIRE FOR HAVANA ACT PAYMENTS Fax Number Added	CD-350 FINAL 508 Compliant 7.13.23.pdf	Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: Survivor Compensation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	0	0

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.