View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 1215-0069	ICR Reference No: 200106-1215-002
Status: Historical Active	Previous ICR Reference No: 199806-1215-001
Agency/Subagency: DOL/ESA	Agency Tracking No:
Title: Survivor's Form for Benefits
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/02/2001
	Date Received in OIRA: 06/13/2001
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2004	08/31/2004	08/31/2001
Responses	2,500	0	3,300
Time Burden (Hours)	333	0	440
Cost Burden (Dollars)	1,000	0	1,000

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