Information Collection

We Need Important Information About Your Eligibility for Social Security Disability Benefits, Our Records Show That You Have Not Received a Decision From the Social Security Administration (SSA)

IC 33719 under ICR 200212-3206-001 · OMB 3206-0216.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0216 can be found here:

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Information Collection (IC) Details

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IC Title:

We Need Important Information About Your Eligibility for Social Security Disability Benefits, Our Records Show That You Have Not Received a Decision From the Social Security Administration (SSA)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	RI-98-7				No	No

Federal Enterprise Architecture Business Reference Module

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,000

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,000	-2,500	5,500
Annual IC Time Burden (Hours)	250	-208	458
Annual IC Cost Burden (Dollars)	0	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.