Information Collection

20 CFR 404.935(d)(4), 416.1435(d)(4)

IC 182507 under ICR 200710-0960-007 · OMB 0960-0764.

Documents and Forms

Document Name Document Type
SSA-3401P.pdf Other-Regulation (NPRM)

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	20 CFR 404.935(d)(4), 416.1435(d)(4)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Regulation (NPRM)			SSA-3401P.pdf		Yes	No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	5	5
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.