WAIVER OF BENEFIT PAYMENTS

ICR 199408-0960-002

OMB: 0960-0533

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
115721 Migrated
ICR Details
0960-0533 199408-0960-002
Historical Active
SSA
WAIVER OF BENEFIT PAYMENTS
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 10/25/1994
Retrieve Notice of Action (NOA) 08/09/1994
  Inventory as of this Action Requested Previously Approved
11/30/1997 11/30/1997
100 0 0
8 0 0
0 0 0

THIS FORM IS USED BY THE SOCIAL SECURITY ADMINISTRATION TO DOCUMENT TH FACT THAT BENEFITS DUE ARE NOT BEING PAID BECAUSE OF A REQUEST FROM TH BENEFICIARY. THE RESPONDENTS ARE BENEFICIARIES WHO USE THESE FORMS TO REQUEST THAT THEY NOT BE PAID.

None
None


No

1
IC Title Form No. Form Name
WAIVER OF BENEFIT PAYMENTS SSA-149

  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 100 0 0 100 0 0
Annual Time Burden (Hours) 8 0 0 8 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
08/09/1994


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