Information Collection

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

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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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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:

table that charts list of 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 %

table that charts list of burden
	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

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.