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

Statement of Death by Funeral Director and State Death Match

Documents and Forms

Document Name Document Type
Death Screen Images.pdf Other-Death Screen Images
Death Screen Images.pdf Other-Death Screen Images

Information Collection (IC) Details

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: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.301 20 CFR 404.310-404.311 20 CFR 404.316 20 CFR 404.330-404.341 20 CFR 404.350-404.352 20 CFR 404.371 20 CFR 404.715 20 CFR 404.720 20 CFR 416.912

Information Collection 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: 1	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,247	0	-311,753	313,000
Annual IC Time Burden (Hours)	312	312	0	0
Annual IC Cost Burden (Dollars)	4,651	0	-987,559	992,210

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.