OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 200009-3206-001 · OMB 3206-0172 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
33650 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 Form Migrated
ICR Details
3206-0172 200009-3206-001
Historical Active 199810-3206-004
OPM
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
Revision of a currently approved collection   No
Regular
Approved without change 12/18/2000
Retrieve Notice of Action (NOA) 09/20/2000
  Inventory as of this Action Requested Previously Approved
12/31/2003 12/31/2003 12/31/2001
8,061 0 8,061
8,061 0 8,061
0 0 0
The Application for Death Benefits/FERS (SF-3104) will be used to apply for benefits under the Federal Employee's Retirement System based on the death of an employee, former employee or retiree who was covered by FERS at the time of his/her death or separation from Federal Service. Documentation and Elections in Support of Application for Death Benefits When Deceased was an Employee at the Time of Death (SF 3104B) is used by applicants for death benefits undeer FERS if the deceased was a Federal Employee at the time of death.
None
None
No
  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 8,061 8,061 0 0 0 0
Annual Time Burden (Hours) 8,061 8,061 0 0 0 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.
09/20/2000