Information Collection

20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a)

IC 9680 under ICR 200804-0960-005 · OMB 0960-0644.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0644 can be found here:

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Information Collection (IC) Details

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IC Title:	20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 411.140(d)(3) 20 CFR 411.150(b)(3) 20 CFR 411.325(a)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,983	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,983	-244,681	248,664
Annual IC Time Burden (Hours)	15,932	-977,452	993,384
Annual IC Cost Burden (Dollars)	0	0	0

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