Information Collection

September 11th Victim Compensation Registration Form

IC 199461 under ICR 201201-1105-003 · OMB 1105-0092.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1105-0092 can be found here:

Documents and Forms

Document Name Document Type
Screen Shots 09262011.doc Other-Screen Shots
OMB Number 1123-00 Deceased Compensation Form Deceased Compensation Form - unformatted_102811.doc Form and Instruction
OMB Number 1123-00 Deceased Eligibility Form Deceased Eligibility Form 10282011 939PM.PDF Form and Instruction
OMB Number 1123-00 PI Compensation Form PI Compensation Form - unformatted.doc Form and Instruction
OMB Number 1123-00 PI Eligibility Form Final PI Eligibility Form FINAL 10272011 907PM.PDF Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	September 11th Victim Compensation Registration Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screen Shots			Screen Shots 09262011.doc	Yes	Yes	Fillable Fileable
Form and Instruction	OMB Number 1123-0012	Deceased Compensation Form	Deceased Compensation Form - unformatted_102811.doc	Yes	Yes	Fillable Fileable
Form and Instruction	OMB Number 1123-0012	Deceased Eligibility Form	Deceased Eligibility Form 10282011 939PM.PDF	Yes	Yes	Fillable Fileable
Form and Instruction	OMB Number 1123-0012	PI Compensation Form	PI Compensation Form - unformatted.doc	Yes	Yes	Fillable Fileable
Form and Instruction	OMB Number 1123-0012	PI Eligibility Form Final	PI Eligibility Form FINAL 10272011 907PM.PDF	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 70,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-70,000	70,000
Annual IC Time Burden (Hours)	-700,000	700,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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