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Federal forms, ICRs, and supporting documents

Information Collection

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

IC 33651 under ICR 202211-3206-003 · OMB 3206-0172.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

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
 
No Modified
 
Required to Obtain or Retain Benefits
 
5 CFR 843

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Standard Form 3104 Application for Death Benefits: FERS SF3104_2020_07.pdf www.opm.gov Yes No Fillable Printable
Form and Instruction Standard Form 3104B Documentation and Elections in Support of Application for Death Benefits when Deceased was an Employee at the Time of Death (FERS) SF3104B_2020_07.pdf www.opm.gov Yes No Fillable Printable

General Government Central Personnel

OPM/Central-1  73 FR 15013

16,751 0
   
Individuals or Households
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 16,751 0 0 0 0 16,751
Annual IC Time Burden (Hours) 16,751 0 0 0 0 16,751
Annual IC Cost Burden (Dollars) 225,066 0 0 0 0 225,066

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.