Information Collection

Certificate Of Support

IC 166344 under ICR 198408-0960-023 · OMB 0960-0001.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0001 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

CERTIFICATE OF SUPPORT

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-760-F4				No	No
Form	(5-83)				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,000

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	18,000	8,000	10,000
Annual IC Time Burden (Hours)	4,500	2,000	2,500
Annual IC Cost Burden (Dollars)	0	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.