Information Collection

Eligibility Verification Reports

IC 28277 under ICR 200203-2900-007 · OMB 2900-0101.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0101 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

Eligibility Verification Reports

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:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	21-0511V-1	No	No
Form	21-0512S	No	No
Form	21-0512V	No	No
Form	21-0512S-1	No	No
Form	21-0512V-1	No	No
Form	21-0510	No	No
Form	21-0511S	No	No
Form	21-0513	No	No
Form	21-0511V	No	No
Form	21-0511S-1	No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 293,894

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	293,894	293,894
Annual IC Time Burden (Hours)	146,947	146,947
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.