Information Collection

Community Work Experience Financial Records

IC 115132 under ICR 198405-0960-002 · OMB 0960-0256.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0256 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

COMMUNITY WORK EXPERIENCE FINANCIAL RECORDS

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	SSA-4767				No	No
Form	9-81				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	23	23
Annual IC Time Burden (Hours)	460	460
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.