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Federal forms, ICRs, and supporting documents

Information Collection Request

APPLICATION FOR GRANT OF AN ANNUITY PURSUANT TO SECTION 523 (C) P.L.94-350, APPROVED 7/12/76

ICR 197807-1405-004 · OMB 1405-0024 · Historical Active

Forms and Documents
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IC IDCollectionTypeStatusForm
124169 APPLICATION FOR GRANT OF AN ANNUITY PURSUANT TO SECTION 523 (C) P.L.94-350, APPROVED 7/12/76 Form Migrated
ICR Details
1405-0024 197807-1405-004
Historical Active 197608-1405-001
STATE/AFA
APPLICATION FOR GRANT OF AN ANNUITY PURSUANT TO SECTION 523 (C) P.L.94-350, APPROVED 7/12/76
Extension without change of a currently approved collection   No
Regular
Approved without change 08/01/1978
Retrieve Notice of Action (NOA) 07/14/1978
  Inventory as of this Action Requested Previously Approved
08/31/1981 08/31/1981 08/31/1978
10 0 70
3 0 20
0 0 0
SECTION 523(C) OF PUBLIC LAW 94-350, AUTHORIZED THE SECRETARY OF STATE TO GRANT ANNUITIES TO CERTAIN WIDOWS OF FOREIGN SERVICE OFFICERS AND EMPLOYEES WHO WERE NOT ENTITLED TO RECEIVE ANNUITY BENEFITS UNDER THE FOREIGN SERVICE RETIREMENT AND DISABILITY SYSTEM. THE DATA GATHERED ON DSP-91 WILL ENABLE THE DEPARTMENT TO DETERMINE IF THAT INDIVIDUAL IS ELIGIBLE FOR THE GRANT.
None
None
No
1
IC Title Form No. Form Name
APPLICATION FOR GRANT OF AN ANNUITY PURSUANT TO SECTION 523 (C) P.L.94-350, APPROVED 7/12/76 DSP-91
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 10 70 0 0 -60 0
Annual Time Burden (Hours) 3 20 0 0 -17 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
07/14/1978