Information Collection

Fugitive Felon Model Agreement

IC 181823 under ICR 200612-0960-004 · OMB 0960-0750.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Fugitive Felon Model Agreement 04-23-07.doc	Instruction
PRA Language Fugitive Felon Agreement 05-13-07.doc	Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 416.1339 20 CFR 404.471

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
Instruction			PRA Language Fugitive Felon Agreement 05-13-07.doc		Yes	Yes	Fillable Fileable Signable
Instruction			Fugitive Felon Model Agreement 04-23-07.doc		Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

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	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	120	120
Annual IC Cost Burden (Dollars)	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.