Information Collection

State Agency Report of Obligations for SSA Disability Programs and Addendum; Time Report of Personnel Services for Disability Determination Services & State Agency Schedule of Equipment.....

IC 9272 under ICR 200105-0960-003 · OMB 0960-0421.

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Documents and Forms

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Information Collection (IC) Details

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IC Title:	State Agency Report of Obligations for SSA Disability Programs and Addendum; Time Report of Personnel Services for Disability Determination Services & State Agency Schedule of Equipment.....	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	SSA-4514	Yes	Yes
Form	SSA-871	Yes	Yes
Form	SSA-4513	Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 54	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 20 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	648	432	216
Annual IC Time Burden (Hours)	756	540	216
Annual IC Cost Burden (Dollars)	0	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.