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

IC 33649 under ICR 199810-3206-004 · 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	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	SF-3104B				No	No
Form	SF-3104				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8,061	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	8,061	1,087	6,974
Annual IC Time Burden (Hours)	8,061	1,087	6,974
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.