Information Collection

c: 20 CFR 404.2121 & 416.2221

IC 45274 under ICR 200609-0960-021 · OMB 0960-0310.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0310 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-199 c: 20 CFR 404.2121 & 416.2221 Form
SSA-199 Vocational Rehabilitation Provider Claim SSA-199.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	c: 20 CFR 404.2121 & 416.2221	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.2121 20 CFR 416.2221

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-199	Vocational Rehabilitation Provider Claim	SSA-199.pdf		No		Paper Only

Line of Business: Income Security

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 80	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	333	333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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