Annuity Application (Exchange Form 1450-011)

Exchange Employee and Retirement Benefit System

Documents and Forms

Document Name Document Type
Form Exchange Form 1450 Annuity Application (Exchange Form 1450-011) Form and Instruction
Exchange Form 1450 Annuity Application EXCHANGE FORM 1450-011 - ANNUITY APPLICATION.pdf Form and Instruction
Exchange Form 1450 Annuity Application EXCHANGE FORM 1450-011 - ANNUITY APPLICATION.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Annuity Application (Exchange Form 1450-011)	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
Form and Instruction	Exchange Form 1450-011	Annuity Application	EXCHANGE FORM 1450-011 - ANNUITY APPLICATION.pdf		Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 320	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	320	0	320
Annual IC Time Burden (Hours)	107	27	80
Annual IC Cost Burden (Dollars)	3,724	1,564	2,160

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.