[Federal Register Volume 69, Number 17 (Tuesday, January 27, 2004)]
[Notices]
[Pages 3957-3958]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-1593]


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OFFICE OF PERSONNEL MANAGEMENT


Submission for OMB Review; Comment Request for Reclearance of a 
Revised Information Collection: SF 3104, SF 3104A and SF 3104B

AGENCY: Office of Personnel Management.

ACTION: Notice.

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SUMMARY: In accordance with the Paperwork Reduction Act of 1995 (Public 
Law 104-13, May 22, 1995), this notice announces that the Office of 
Personnel Management (OPM) has submitted to the Office of Management 
and Budget (OMB) a request for reclearance of a revised information 
collection. SF 3104, Application for Death Benefits/Federal Employees 
Retirement System (FERS), is used by persons applying for death 
benefits which may be payable under FERS because of 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 3104A, 
Survivor Supplement (FERS) (attached to the SF 3104) requests 
information from the survivor which is used by OPM to determine 
entitlement to a survivor annuity supplement (supplementary annuity). 
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.
    It is estimated that approximately 7,481 SF 3104s will be processed 
annually. This form requires approximately 60 minutes to complete. An 
annual burden of 7,481 hours is estimated. Approximately 3,366 SF 
3104Bs are expected to be processed annually. It is estimated that the 
form requires approximately 60 minutes to complete. An annual burden of 
3,366 hours is estimated. The total annual burden is 10,847.
    For copies of this proposal, contact Mary Beth Smith-Toomey on 
(202) 606-8358, FAX (202) 418-3251 or via E-mail to [email protected]. 
Please include a mailing address with your request.

DATES: Comments on this proposal should be received on or before 
February 26, 2004.

ADDRESSES: Send or deliver comments to--

Ronald W. Melton, Chief, Operations Support Group, Center for 
Retirement and Insurance Services, U.S. Office of Personnel Management, 
1900 E Street,

[[Page 3958]]

NW., Room 3425, Washington, DC 20415-3660;
 and
Joseph F. Lackey, OPM Desk Officer, Office of Information & Regulatory 
Affairs, Office of Management and Budget, New Executive Office 
Building, NW., Room 10235, Washington, DC 20503.


FOR FURTHER INFORMATION CONTACT: Cyrus S. Benson, Team Leader, 
Publications Team, RIS Support Services, (202) 606-0623.

U.S. Office of Personnel Management.
Kay Coles James,
Director.
[FR Doc. 04-1593 Filed 1-26-04; 8:45 am]
BILLING CODE 6325-50-P