Information Collection

Quarterly Statistical Report on Recipients and Payments Under State-Administered Assistance Programs for Aged, Blind, and Disabled Recipients

IC 9109 under ICR 200806-0960-003 · OMB 0960-0130.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-9741 Quarterly Statistical Report on Recipients and Payments Under State-Administered Assistance Programs for Aged, Blind, and Disabled Recipients	Form and Instruction
SSA-9741 Quarterly Statistical Report on Recipients and Payments Form SSA-9174 (0960-0130).pdf	Form and Instruction
new 0960-0130 PRA statement[1].doc New PRA Statement	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 416.2010 20 CFR 416.2098

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-9741	Quarterly Statistical Report on Recipients and Payments Under State Administered State Assistance Programs for Aged, Blind, and Disabled Recipients	Form SSA-9174 (0960-0130).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: 31

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	124	124
Annual IC Time Burden (Hours)	124	124
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
New PRA Statement	new 0960-0130 PRA statement[1].doc	06/05/2008

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