Information Collection

Participant Benefit Application Survey

IC 219507 under ICR 201406-1212-015 · OMB 1212-0066.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0066 can be found here:

Documents and Forms

Document Name Document Type
BAPD Participant Benefit Application Survey - Email message.docx Instruction
Participant Benefit Application Survey 1-2016.docx Other-Survey
Generic Clearance Submission for Benefit Application Survey 1-2016.docx Generic Clearance Submission for Participant Benefit Application Survey IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Participant Benefit Application Survey	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			BAPD Participant Benefit Application Survey - Email message.docx		Yes	No	Printable Only
Other-Survey			Participant Benefit Application Survey 1-2016.docx		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 250	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	63	63
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Generic Clearance Submission for Participant Benefit Application Survey	Generic Clearance Submission for Benefit Application Survey 1-2016.docx	01/06/2016

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