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September 11th Victim Compensation Registration Form
September 11th Victim Compensation Fund Claimant Registration Form
OMB: 1123-0012
IC ID: 199461
OMB.report
DOJ/CD
OMB 1123-0012
ICR 201110-1123-001
IC 199461
( )
Documents and Forms
Document Name
Document Type
Screen Shots 09262011.doc
Other-Screen Shots
OMB Number 1123-00 Deceased Compensation Form
Deceased Compensation Form - unformatted_102811.doc
Form and Instruction
OMB Number 1123-00 Deceased Eligibility Form
Deceased Eligibility Form 10282011 939PM.PDF
Form and Instruction
OMB Number 1123-00 PI Compensation Form
PI Compensation Form - unformatted.doc
Form and Instruction
OMB Number 1123-00 PI Eligibility Form Final
PI Eligibility Form FINAL 10272011 907PM.PDF
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
September 11th Victim Compensation Registration Form
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Screen Shots
Screen Shots 09262011.doc
Yes
Yes
Fillable Fileable
Form and Instruction
OMB Number 1123-0012
Deceased Compensation Form
Deceased Compensation Form - unformatted_102811.doc
Yes
Yes
Fillable Fileable
Form and Instruction
OMB Number 1123-0012
Deceased Eligibility Form
Deceased Eligibility Form 10282011 939PM.PDF
Yes
Yes
Fillable Fileable
Form and Instruction
OMB Number 1123-0012
PI Compensation Form
PI Compensation Form - unformatted.doc
Yes
Yes
Fillable Fileable
Form and Instruction
OMB Number 1123-0012
PI Eligibility Form Final
PI Eligibility Form FINAL 10272011 907PM.PDF
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
General Government
Subfunction:
Executive Functions
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
70,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
75 %
Approved
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
70,000
0
0
0
0
70,000
Annual IC Time Burden (Hours)
700,000
0
676,900
0
0
23,100
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.