Information Collection

Application for disposition of Retirement Plan/Individual Retirement Bonds Without Admin. of Deceased Owners Estate

IC 16523 under ICR 202509-1530-004 · OMB 1530-0032.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FS Form 3565 Application for disposition of Retirement Plan/Individual Retirement Bonds Without Admin. of Deceased Owners Estate	Form and Instruction
Form FS Form 3565 Application for Disposition of Retirement Plan and/or Individual Retirement Bonds Without Administration of Deceased Owner’s Estate Application for disposition of Retirement Plan/Individual Retirement Bonds Without Admin. of Deceased Owners Estate	Form and Instruction
FS Form 3565 Application for Disposition of Retirement Plan and/or In sav3565.pdf www.treasurydirect.gov/forms/sav3565.pdf	Form and Instruction
FS Form 3565 Application for Disposition of Retirement Plan and/or In sav3565.pdf www.treasurydirect.gov/forms/sav3565.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 31 CFR 346.9

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
Form and Instruction	FS Form 3565			http://www.treasurydirect.gov/forms/sav3565.pdf	Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records

Title: Treasury/Fiscal Service .014âUnited States Securities and Access

FR Citation: 85 FR 11776

Number of Respondents: 315

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	315	-35	350
Annual IC Time Burden (Hours)	105	-12	117
Annual IC Cost Burden (Dollars)	0	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.

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