Information Collection

Agreement Between SSA and the Law Enforcement Agency or Source Jurisdiction

IC 46296 under ICR 200612-0960-004 · OMB 0960-0750.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Fugitive Felon reporting Screens 05-11-07.pdf	Other-Application Screens
PRA Language Fugitive Felon Agreement 05-13-07.doc Fugitive Felon PRA Language Addendum to Agreement	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.471 20 CFR 416.1339

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
Other-Application Screens			Fugitive Felon reporting Screens 05-11-07.pdf		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 28

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	196	196
Annual IC Time Burden (Hours)	196	196
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fugitive Felon PRA Language Addendum to Agreement	PRA Language Fugitive Felon Agreement 05-13-07.doc	05/13/2007

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