Information Collection

Request to Resolve Questionable Quarters of Coverage (QC)

IC 9530 under ICR 200612-0960-005 · OMB 0960-0575.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-512 Request to Resolve Questionable Quarters of Coverage (QC)	Form
SSA-512 Request to Resolve Questionable Quarters of Coverage S512.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:

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-512	Request to Resolve Questionable Quarters of Coverage	S512.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200,000

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 Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	200,000	-350,000	550,000
Annual IC Time Burden (Hours)	6,667	-11,667	18,334
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.