[Federal Register Volume 60, Number 140 (Friday, July 21, 1995)]
[Notices]
[Pages 37694-37695]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-17962]



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OFFICE OF PERSONNEL MANAGEMENT


Notice of Request for Clearance of a Revised Information 
Collection Form SF 3104 and SF 3104B

AGENCY: Office of Personnel Management.

ACTION: Notice.

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SUMMARY: In accordance with the Paperwork Reduction Act of 1980 (title 
44, U.S. Code, chapter 35), this notice announces a request for a 
clearance of a revised information collection. SF 3104, Application for 
Death Benefits/Federal Employees Retirement System, is used to apply 
for benefits under the Federal Employees Retirement System based on the 
death of an employee, former employee or retiree who was covered by 
FERS at the time of his/her death or separation from Federal Service. 
SF 3104B, Documentation and Elections in Support of Application for 
Death Benefits when Deceased was an Employee at the Time of Death, is 
used by applicants for death benefits under FERS if the deceased was a 
Federal Employee at the time of death.
    Approximately 4,054 SF 3104s are completed annually. We estimate 
that it takes 60 minutes to fill out the form. The annual burden is 
4,054 hours. Approximately 2,920 SF 3104Bs are completed annually. We 
estimate that it takes 60 minutes to fill out the form. The annual 
burden is 2,920 hours. The combined total annual burden is 6,974 hours.
    For copies of this proposal, contact Doris R. Benz on (703) 908-
8564.

DATES: Comments on this proposal should be received by August 20, 1995.

ADDRESSES: Send or deliver comments to--

Daniel A. Green, Retirement and Insurance Service, FERS Division,

[[Page 37695]]
U.S. Office of Personnel Management, 1900 E Street, NW., Room 4429, 
Washington, DC 20415
    and
Joseph Lackey, OPM Desk Officer, Office of Information and Regulatory 
Affairs, Office of Management and Budget, New Executive Office 
Building, NW, Room 10235, Washington, DC 20503.

FOR INFORMATION REGARDING ADMINISTRATIVE COORDINATION CONTACT:
Mary Beth Smith-Toomey, Team Leader, Forms Analysis and Design, (202) 
606-0623.

U.S. Office of Personnel Management
Lorraine A. Green,
Deputy Director.
[FR Doc. 95-17962 Filed 7-20-95; 8:45 am]
BILLING CODE 6325-01-M