Information Collection

a: 20 CFR 404.2108 & 416.2208

IC 9208 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form SSA-199 a: 20 CFR 404.2108 & 416.2208	Form
SSA-199 Vocational Rehabilitation Provider Claim SSA-199.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.2208 20 CFR 404.2108

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-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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	12,800	-3,500	16,300
Annual IC Time Burden (Hours)	4,907	-4,141	9,048
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.