Information Collection Request
Application for Death Benefits (FERS)/Documentation and Elections in Support of Application for Death Benefits when Deceased was an Employee at the Time of Death (FERS)
ICR 202211-3206-003 · OMB 3206-0172 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form Standard Form 3104 Application for Death Benefits (FERS); Documentation and Elections in Support of Application for Death Benefits when Deceased was an Employee at the Time of Death |
Form and Instruction | Modified | Available |
 SF3104_OMB_Supporting_Stmt_2022_4_19.docx |
Supporting Statement A | Uploaded 2022-11-15 | Repair queued |
 FACES 2017 FINAL 12212017signed.pdf |
Supplementary Document | Uploaded 2022-11-15 | Repair queued |
| ARS PIA Final 12212017signed.pdf |
Supplementary Document | Uploaded 2022-11-15 | Repair queued |
| SF3104_30DayFRNPublished_2022_08_24.PDF |
Supplementary Document | Uploaded 2022-11-15 | Missing upstream |
| SF3104_60DAYFRN_Published_2022_02_18.pdf |
Supplementary Document | Uploaded 2022-11-15 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 33651 |  Application for Death Benefits (FERS); Documentation and Elections in Support of Application for Death Benefits when Deceased was an Employee at the Time of Death |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | OPM |
| OMB Control No | 3206-0172 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 202203-3206-009 |
| Agency Tracking No | SF 3104/SF 3104B |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |