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

Document Name Document Type
SSA-871 Instructions.pdf Instruction
SSA-871 State Agency Schedule of Equipment Purchased for SSA Dis 871_form.xls Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State Agency Schedule of Equipment Purchased for SSA Disability Programs	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			SSA-871 Instructions.pdf		No		Fillable Fileable
Form	SSA-871	State Agency Schedule of Equipment Purchased for SSA Disability Programs	871_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 %

	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

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.