Information Collection

Summary Report On Claims Of Good Cause...and Case Report On Claim Of Good Cause

IC 114998 under ICR 197909-0960-001 · OMB 0960-0177.

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Documents and Forms

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IC Title:

SUMMARY REPORT ON CLAIMS OF GOOD CAUSE...AND CASE REPORT ON CLAIM OF GOOD CAUSE

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-4680				No	No
Form	& SSA-4681				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 54

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	40,068	40,068
Annual IC Time Burden (Hours)	7,210	7,210
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.