Information Collection

Public Safety Officers' Death Benefits Application

IC 227411 under ICR 202401-1121-004 · OMB 1121-0220.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
death part A.xlsx	Other-questions
death part A.xlsx	Other-questions
Death part A with required docs.xlsx	Other-questions that require documen
Death part A with required docs.xlsx	Other-questions that require documen
death part B.xlsx	Other-questions
death part B.xlsx	Other-questions
Death part B with required docs.xlsx	Other-questions that require documen
Death part B with required docs.xlsx	Other-questions that require documen

IC Title:

Agency IC Tracking Number:

BJA

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-questions	death part A.xlsx	n/a	Yes	Yes	Fillable Fileable
Other-questions that require documents	Death part A with required docs.xlsx	n/a	Yes	Yes	Fillable Fileable
Other-questions	death part B.xlsx	n/a	Yes	Yes	Fillable Fileable
Other-questions that require documents	Death part B with required docs.xlsx	n/a	Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 350

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	Previously Approved
Annual Number of Responses for this IC	350	350
Annual IC Time Burden (Hours)	2,100	2,100
Annual IC Cost Burden (Dollars)	0	0

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.