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Federal forms, ICRs, and supporting documents

Information Collection Request

NOTIFY US IF YOUR CHILD IS UNABLE TO QUALIFY FOR SURVIVOR BENEFITS

ICR 198109-3206-003 · OMB 3206-0103 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
156860 NOTIFY US IF YOUR CHILD IS UNABLE TO QUALIFY FOR SURVIVOR BENEFITS Form Migrated
ICR Details
3206-0103 198109-3206-003
Historical Active 197912-3206-001
OPM
NOTIFY US IF YOUR CHILD IS UNABLE TO QUALIFY FOR SURVIVOR BENEFITS
Revision of a currently approved collection   No
Regular
Approved without change 10/30/1981
Retrieve Notice of Action (NOA) 09/29/1981
  Inventory as of this Action Requested Previously Approved
10/31/1984 10/31/1984 01/31/1982
2,000 0 10,000
167 0 833
0 0 0
THIS FORM IS USED TO INFORM OPM OF CHANGES IN A CHILD'S STATUS WHICH WOULD MAKE HIM OR HER INELIGIBLE FOR ANNUITY PAYMENTS IN ORDER TO AVOI AN OVERPAYMENT OF ANNUITY AND THE RESULTING RECOVERY ACTIONS.
None
None
No
1
IC Title Form No. Form Name
NOTIFY US IF YOUR CHILD IS UNABLE TO QUALIFY FOR SURVIVOR BENEFITS BRI 49-235A
  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 2,000 10,000 0 0 -8,000 0
Annual Time Burden (Hours) 167 833 0 0 -666 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.
09/29/1981