CLAIMANT'S WORK BACKGROUND

ICR 198205-0960-002

OMB: 0960-0300

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
115246 Migrated
ICR Details
0960-0300 198205-0960-002
Historical Active
SSA
CLAIMANT'S WORK BACKGROUND
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 06/15/1982
Retrieve Notice of Action (NOA) 05/06/1982
  Inventory as of this Action Requested Previously Approved
05/31/1984 05/31/1984
25,000 0 0
6,250 0 0
0 0 0

THE INFORMATION COLLECTED IN COMPLETING THIS FORM IS NEEDED AND USED TO AFFORD CLAIMANTS THEIR STATUTORY RIGHT TO A HEARING AND DECISION UNDER THE SOCIAL SECURITY ACT.

None
None


No

1
IC Title Form No. Form Name
CLAIMANT'S WORK BACKGROUND HA-4633, (6-81)

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 25,000 0 0 0 25,000 0
Annual Time Burden (Hours) 6,250 0 0 0 6,250 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
05/06/1982


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