View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 1215-0069	ICR Reference No: 199806-1215-001
Status: Historical Active	Previous ICR Reference No: 199601-1215-002
Agency/Subagency: DOL/ESA	Agency Tracking No:
Title: Survivor's Form for Benefits
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/18/1998
	Date Received in OIRA: 06/09/1998
Terms of Clearance: Approved on the condition that DOL provide a response to questions raised on July 24 by OMB, addressing the utility of certain data elements that are proposed for deletion. Prior to implementation of the new form, DOL will respond to these questions and resolve any issues that remain.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2001	08/31/2001	03/31/1999
Responses	3,300	0	1,200
Time Burden (Hours)	440	0	500
Cost Burden (Dollars)	1,000	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate
Annual Number of Responses	3,300	1,200	11,900	-9,800
Annual Time Burden (Hours)	440	500	-340	280
Annual Cost Burden (Dollars)	1,000	0	1,000	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to:

Short Statement:

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