APPLICATION FOR DEATH BENEFITS (FERS), SURVIVOR SUPPLEMENT (FERS), AND DOCUMENTATION OF ELECTIONS IN SUPPORT OF APPLICATION FOR DEATH BENEFITS WHEN DECEASED WAS AN ...
ICR 199406-3206-010 · OMB 3206-0172 · Historical Active
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 3206-0172 can be found here:
APPLICATION FOR DEATH BENEFITS (FERS), SURVIVOR SUPPLEMENT (FERS), AND DOCUMENTATION OF ELECTIONS IN SUPPORT OF APPLICATION FOR DEATH BENEFITS WHEN DECEASED WAS AN ...
For OPM's consideration, OMB has provided under seperate cover a number of minor suggestions for changes to increase clarity. OPM should provide to OMB a new version of this form indicating those changes it has adopted.
Inventory as of this Action
Requested
Previously Approved
06/30/1997
06/30/1997
06/30/1994
6,312
0
3,926
6,312
0
3,926
0
0
0
THIS DATA IS NEEDED IN ORDER FOR THE OFFICE OF PERSONNEL MANAGEMENT TO DETERMINE WHETHER DEATH BENEFITS SHOULD BE PAID, TO WHOM, AND IN WHAT AMOUNT.
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.
APPLICATION FOR DEATH BENEFITS (FERS), SURVIVOR SUPPLEMENT (FERS), AND DOCUMENTATION OF ELECTIONS IN SUPPORT OF APPLICATION FOR DEATH BENEFITS WHEN DECEASED WAS AN ...