Information Collection

State Agency Schedule of Equipment Purchased for SSA Disability Programs

IC 180190 under ICR 200705-0960-010 · OMB 0960-0421.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-871 State Agency Schedule of Equipment Purchased for SSA Disability Programs State Agency Schedule of Equipment Purchased for SSA Disability Programs	Form
SSA-871 Instructions.pdf	Instruction
SSA-871 State Agency Schedule of Equipment Purchased for SSA Dis 871_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 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					No		Fillable Fileable
Form	SSA-871				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)	104	104
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.

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