Information Collection

Request for Program Consultation

IC 179424 under ICR 200704-0960-004 · OMB 0960-0748.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
RPC revised screens.pdf http;//ssahostadmin.ba.ssa.gov/erpctrm	Other-RPC Screen Shots

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.1601 20 CFR 404.1603 20 CFR 404.1615 20 CFR 404.1641-.1661 20 CFR 404.1620 20 CFR 404.1626 20 CFR 404.1633

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-RPC Screen Shots			RPC revised screens.pdf	http;//ssahostadmin.ba.ssa.gov/erpctrm	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: 4,500

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,500	4,500
Annual IC Time Burden (Hours)	2,250	2,250
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.