Information Collection

Claim Documentation Form - Conscientious Objector

IC 35545 under ICR 200709-3240-001 · OMB 3240-0028.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3240-0028 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSS-22 Claim Documentation Form - Conscientious Objector	Form
SSS-22 Claim Documentation Form - Conscientious Objector sss form 22.doc	Form

IC Title:

Claim Documentation Form - Conscientious Objector

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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
Form	SSS-22	Claim Documentation Form - Conscientious Objector	sss form 22.doc		No		Paper Only

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title: SSS-5 Registrant Processing Records

FR Citation: 65 FR 184

Number of Respondents: 1

Number of Respondents for Small Entity: 1

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	1	1
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.