Information Collection

Referral And Treatment Status Of Ssi Drug Addicts Or Alcoholics

IC 115334 under ICR 199011-0960-004 · OMB 0960-0331.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0331 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	REFERRAL AND TREATMENT STATUS OF SSI DRUG ADDICTS OR ALCOHOLICS	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	SSA-8740				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 27,000	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	27,000	9,000	18,000
Annual IC Time Burden (Hours)	4,500	1,500	3,000
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.