Information Collection

Annual Income Questionnaire For Pension And Instructions For Completion

IC 174342 under ICR 198107-2900-053 · OMB 2900-0135.

Documents and Forms

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Document Name	Document Type

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IC Title:

ANNUAL INCOME QUESTIONNAIRE FOR PENSION AND INSTRUCTIONS FOR COMPLETION

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

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	21-6875 &				No	No
Form	21-6875A				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 910,000

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	Previously Approved
Annual Number of Responses for this IC	910,000	910,000
Annual IC Time Burden (Hours)	303,333	303,333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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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.