Information Collection

Summary of Evidence, 20 CFR 404.913(b), 404.914(a), 416.1407, 416.1413(b), and 416.1414(a)

IC 9284 under ICR 200405-0960-011 · OMB 0960-0430.

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Documents and Forms

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IC Title:

Summary of Evidence, 20 CFR 404.913(b), 404.914(a), 416.1407, 416.1413(b), and 416.1414(a)

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.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-887				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 49,000

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	49,000	49,000
Annual IC Time Burden (Hours)	12,250	12,250
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.

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