Information Collection

Claimant's Work Background

IC 166767 under ICR 198508-0960-050 · OMB 0960-0300.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0300 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	CLAIMANT'S WORK BACKGROUND	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HA-4633				No	No
Form	(6-81)				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	60,000	10,000	50,000
Annual IC Time Burden (Hours)	15,000	2,500	12,500
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.