Information Collection

Private Printing and Modification of Prescribed Application and Other Forms

IC 9711 under ICR 200712-0960-007 · OMB 0960-0663.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0663 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-1010 Private Printing and Modification of Prescribed Application and Other Forms	Form and Instruction
SSA-1010 Request to Reproduce, Reprint, or Distribute SSA Forms, SSA-1010.pdf	Form and Instruction
0663 Final Rules.pdf Regulation Section 422.527	IC Document

IC Title:

Private Printing and Modification of Prescribed Application and Other Forms

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 422.527

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 and Instruction	SSA-1010	Request to Reproduce, Reprint, or Distribute SSA Forms, Applications, or other Publications	SSA-1010.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: 9

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	324	324
Annual IC Time Burden (Hours)	43	43
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Regulation Section 422.527	0663 Final Rules.pdf	12/28/2007

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.