Claim Certification and
Voucher for Death Gratuity Payment
Revision of a currently approved collection
No
Regular
05/27/2021
Requested
Previously Approved
36 Months From Approved
05/31/2021
500
500
250
250
1,813
1,813
This form is used to document and
approve death gratuity payments. The Service Casualty Office
completes part of the form and provides the form to the Service
Member's beneficiaries to complete and sign their portion of the
form. The form is sent to DFAS for payment.
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.