Information Collection

Time Report of Personnel Services for Disability Determination Services--SSA-4514

IC 180189 under ICR 200705-0960-010 · OMB 0960-0421.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-4514 Time Report of Personnel Services for Disability Determination Services Time Report of Personnel Services for Disability Determination Services--SSA-4514	Form
SSA-4514 Instructions.pdf	Instruction
SSA-4514 Time Report of Personnel Services for Disability Determi 4514_form.xls	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 404.1626

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			SSA-4514 Instructions.pdf		No		Fillable Fileable
Form	SSA-4514	Time Report of Personnel Services for Disability Determination Services	4514_form.xls		No		Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 52

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
Annual Number of Responses for this IC	208	208
Annual IC Time Burden (Hours)	312	312
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.