Information Collection

Quality Review Questionnaire-disability: Insured Individual, Spouse And Surviving Spouse, And Children

IC 115043 under ICR 198007-0960-006 · OMB 0960-0216.

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Information Collection (IC) Details

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IC Title:	QUALITY REVIEW QUESTIONNAIRE-DISABILITY: INSURED INDIVIDUAL, SPOUSE AND SURVIVING SPOUSE, AND CHILDREN	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	SSA-4678,	No	No
Form	2930, 2931,	No	No
Form	& 2932	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	3,000	3,000
Annual IC Time Burden (Hours)	3,000	3,000
Annual IC Cost Burden (Dollars)	0	0

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Title	Document	Date Uploaded

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