Information Collection

Beneficiary Designation (Exchange Form 1700-012)

IC 222966 under ICR 202512-0702-002 · OMB 0702-0139.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Exchange Form 1700 Beneficiary Designation (Exchange Form 1700-012)	Form and Instruction
Form Exchange Form 1700 Beneficiary Designation Beneficiary Designation (Exchange Form 1700-012)	Form and Instruction
Exchange Form 1700 Beneficiary Designation EXCHANGE FORM 1700-012 - BENEFICIARY DESIGNATION.pdf	Form and Instruction
Exchange Form 1700 Beneficiary Designation EXCHANGE FORM 1700-012(DRAFT).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:

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	Exchange Form 1700-012				Yes	Yes	Fillable Printable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 250

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	250	0	250
Annual IC Time Burden (Hours)	83	0	83
Annual IC Cost Burden (Dollars)	3,236	327	2,909

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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