Information Collection

Service Delivery Questionnaires (enumerations, Initial Denials, Disallowances, Initial Awards, Redeterminations)

IC 115708 under ICR 199307-0960-002 · OMB 0960-0521.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0521 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	SERVICE DELIVERY QUESTIONNAIRES (ENUMERATIONS, INITIAL DENIALS, DISALLOWANCES, INITIAL AWARDS, REDETERMINATIONS)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	SSA-4298	No	No
Form	4299, 3299	No	No
Form	4000	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 11,000	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
Annual Number of Responses for this IC	11,000	11,000
Annual IC Time Burden (Hours)	3,250	3,250
Annual IC Cost Burden (Dollars)	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.