Information Collection

Summary of Evidence

IC 9284 under ICR 200705-0960-012 · OMB 0960-0430.

Documents and Forms

Document Name Document Type
Form SSA-887 Summary of Evidence Form
SSA-887 Summary of Evidence SSA-887.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Summary of Evidence	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.1413(b) 20 CFR 416.1414(a) 20 CFR 416.1407 20 CFR 404.914(a) 20 CFR 404.913(b)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-887	Summary of Evidence	SSA-887.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 49,000	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	49,000	49,000
Annual IC Time Burden (Hours)	12,250	12,250
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.