Information Collection

Application for Death Benefits/Federal Employees Retirement System Documentation and Elections in Support of Application for Death Benefits When Deceased was an Employee at the Time of Death

IC 157034 under ICR 199507-3206-003 · OMB 3206-0172.

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Documents and Forms

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Information Collection (IC) Details

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IC Title:	Application for Death Benefits/Federal Employees Retirement System Documentation and Elections in Support of Application for Death Benefits When Deceased was an Employee at the Time of Death	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.	Available Electronically?	Can Be Submitted Electronically?
Form	3104A	No	No
Form	3104	No	No
Form	3104B	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,974	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	6,974	6,974	0
Annual IC Time Burden (Hours)	6,974	662	6,312
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

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