Information Collection

Quality Review Questionnaires-insured Individual, Spouse And Surviving Spouse, Children, Aet, And Rsdi

IC 115022 under ICR 198007-0960-005 · OMB 0960-0189.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0189 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	QUALITY REVIEW QUESTIONNAIRES-INSURED INDIVIDUAL, SPOUSE AND SURVIVING SPOUSE, CHILDREN, AET, AND RSDI	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	SSA-2930,	No	No
Form	2931, 2932,	No	No
Form	4649, &	No	No
Form	1398-F7	No	No
Form	SSA-4659	No	No
Form	SSA-2930	No	No
Form	SSA-2931	No	No
Form	SSA-2932	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	8,950	8,950
Annual IC Time Burden (Hours)	4,408	4,408
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

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