STATE CONTRIBUTION RETURN

ICR 198908-0960-007

OMB: 0960-0041

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
114380 Migrated
ICR Details
0960-0041 198908-0960-007
Historical Active 198709-0960-019
SSA
STATE CONTRIBUTION RETURN
Revision of a currently approved collection   No
Regular
Approved without change 10/13/1989
Retrieve Notice of Action (NOA) 08/14/1989
  Inventory as of this Action Requested Previously Approved
10/31/1992 10/31/1992 10/31/1989
10,000 0 10,000
500 0 500
0 0 0

THE INFORMATION COLLECTED BY THIS FORM IS USED BY THE SOCIAL SECURITY ADMINISTRATION TO IDENTIFY AND ACCOUNT FOR ALL CONTRIBUTIONS DUE AND PAID BY THE STATES (OR INTERSTATE INSTRUMENTALITIES) UNDER SECTION 218 OF THE SOCIAL SECURITY ACT. THE RESPONDENTS ARE STATE AGENCIES.

None
None


No

1
IC Title Form No. Form Name
STATE CONTRIBUTION RETURN SSA-3961

  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 10,000 10,000 0 0 0 0
Annual Time Burden (Hours) 500 500 0 0 0 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.
08/14/1989


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