Information Collection

Claim Documentation Form Administrative

IC 35534 under ICR 200807-3240-003 · OMB 3240-0025.

Documents and Forms

Document Name Document Type
Form SSS FORM 21 Claim Documentation Form Administrative Form and Instruction
SSS FORM 21 Claim Documentation Form - Administrative SSS FORM 21.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Claim Documentation Form Administrative	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSS FORM 21	Claim Documentation Form - Administrative	SSS FORM 21.pdf		No		Paper Only

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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