Information Collection

Application For Amounts Due Estates Of Persons Entitled To Benefits

IC 174168 under ICR 198101-2900-019 · OMB 2900-0064.

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Information Collection (IC) Details

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IC Title:	APPLICATION FOR AMOUNTS DUE ESTATES OF PERSONS ENTITLED TO BENEFITS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	21-609				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,000	-500	1,500
Annual IC Time Burden (Hours)	250	-125	375
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.