Information Collection

Questionnaires For Test 5 Of The Personal Earnings And Benefit Estimate Statement Project

IC 166873 under ICR 199106-0960-005 · OMB 0960-0488.

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IC Title:

QUESTIONNAIRES FOR TEST 5 OF THE PERSONAL EARNINGS AND BENEFIT ESTIMATE STATEMENT PROJECT

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	SSA-7005	No	No
Form	TEST 5-1	No	No
Form	5-2 & 5-3	No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,200

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	Previously Approved
Annual Number of Responses for this IC	5,200	5,200
Annual IC Time Burden (Hours)	1,300	1,300
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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Title	Document	Date Uploaded

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