Child Care Dropout Questionnaire

ICR 199807-0960-003

OMB: 0960-0474

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
9365 Migrated
ICR Details
0960-0474 199807-0960-003
Historical Active 199506-0960-001
SSA
Child Care Dropout Questionnaire
Extension without change of a currently approved collection   No
Regular
Approved without change 09/14/1998
Retrieve Notice of Action (NOA) 07/20/1998
  Inventory as of this Action Requested Previously Approved
10/31/2001 10/31/2001 09/30/1998
2,000 0 2,000
167 0 167
0 0 0

The information on form SSA-4162 is used by the Social Security Administration to determine whether zero earnings years can be dropped out when computing a claimant's benefit. The respondents are applicants for disability insurance benefits who may qualify for a higher primary insurance amount because of having a child in care for certain years.

None
None


No

1
IC Title Form No. Form Name
Child Care Dropout Questionnaire SSA-4162

  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 2,000 2,000 0 0 0 0
Annual Time Burden (Hours) 167 167 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.
07/20/1998


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