Information Collection

Baseline Survey Materials

IC 180016 under ICR 200803-0960-021 · OMB 0960-0747.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0747 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix C.pdf Note: completed by interviewer	Other-Survey Script
Appendix D.doc	Other-Consent Forms
Appendix A.doc	Other-Survey Letter
Appendix B.doc	Other-Fact Sheet
0960-0747 revised documents.pdf Revised Materials	IC Document

IC Title:

Baseline Survey Materials

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	URL	Available Electronically?	Electronic Capability
Other-Survey Script	Appendix C.pdf	Note: completed by interviewer	No	Paper Only
Other-Consent Forms	Appendix D.doc		No	Paper Only
Other-Survey Letter	Appendix A.doc		No	Paper Only
Other-Fact Sheet	Appendix B.doc		No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 37,812

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	37,812	37,812
Annual IC Time Burden (Hours)	6,572	6,572
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Revised Materials	0960-0747 revised documents.pdf	03/24/2008

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