Information Collection

Request for Informtion on Earnings, Dual Benefits, Dependents

IC 38464 under ICR 199903-1215-008 · OMB 1215-0151.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1215-0151 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Request for Informtion on Earnings, Dual Benefits, Dependents	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	CA-1032				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	50,000	50,000
Annual IC Time Burden (Hours)	16,667	16,667
Annual IC Cost Burden (Dollars)	17,000	17,000

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.