Information Collection

Eligibility Verification Reports

IC 28278 under ICR 200505-2900-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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Information Collection (IC) Details

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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:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	21-0518	No	No
Form	21-0512S-1	No	No
Form	21-0514	No	No
Form	21-0518-1	No	No
Form	21-0516	No	No
Form	21-0512V-1	No	No
Form	21-0513-1	No	No
Form	21-0514-1	No	No
Form	21-0510	No	No
Form	21-0516-1	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 219,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	219,000	-74,894	293,894
Annual IC Time Burden (Hours)	113,075	-33,872	146,947
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.