Information Collection

Baseline Survey Materials

IC 180016 under ICR 200705-0960-002 · OMB 0960-0747.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0747 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix C.pdf Note: completed by interviewer	Other-Survey Script
Appendix D.doc	Other-Consent Forms
Appendix A.doc	Other-Survey Letter
Appendix B.doc	Other-Fact Sheet

IC Title:

Baseline Survey Materials

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	URL	Available Electronically?	Electronic Capability
Other-Survey Script	Appendix C.pdf	Note: completed by interviewer	No	Paper Only
Other-Consent Forms	Appendix D.doc		No	Paper Only
Other-Survey Letter	Appendix A.doc		No	Paper Only
Other-Fact Sheet	Appendix B.doc		No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 37,812

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	37,812	37,812
Annual IC Time Burden (Hours)	6,572	6,572
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.