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Information Collection

Report To Social Security Administration About Workers' Compensation

IC 166814 under ICR 198903-0960-007 · OMB 0960-0367.

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Information Collection (IC) Details

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REPORT TO SOCIAL SECURITY ADMINISTRATION ABOUT WORKERS' COMPENSATION
 
No Migrated
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-2775 No No


    

90,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 90,000 0 0 0 0 90,000
Annual IC Time Burden (Hours) 7,500 0 0 0 0 7,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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