Information Collection

Government Pension Questionnaire

IC 9142 under ICR 200803-0960-019 · OMB 0960-0160.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0160 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-3885 Government Pension Questionnaire Form
SSA-3885 Government Pension Questionnaire SSA-3885.pdf Form
SSA-3885 Government Pension Questionnaire Modernized Claims Syste MCS Screens for SSA-3885.pdf Form
SSA-3885 (Mock-up for the revision of the typo).pdf Mock-Up SSA-3885 (to show revision of the typo) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Government Pension Questionnaire	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 404.408a

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-3885	Government Pension Questionnaire	SSA-3885.pdf		No		Paper Only
Form	SSA-3885	Government Pension Questionnaire Modernized Claims System Screens	MCS Screens for SSA-3885.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 76,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 60 %

	Approved	Previously Approved
Annual Number of Responses for this IC	76,000	76,000
Annual IC Time Burden (Hours)	15,833	15,833
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Mock-Up SSA-3885 (to show revision of the typo)	SSA-3885 (Mock-up for the revision of the typo).pdf	09/24/2008

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