Information Collection

Record of SSI Inquiry

IC 9121 under ICR 200808-0960-003 · OMB 0960-0140.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-3462 Record of SSI Inquiry	Form
SSA-3462 Record of Supplemental Security Income Inquiry--MSSICS S MSSICS Screens for SSA-3462.pdf	Form
SSA-3462 Record of Supplemental Security Income Inquiry SSA-3462.pdf	Form

IC Title:

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 416.345

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	SSA-3462	Record of Supplemental Security Income Inquiry--MSSICS Screens	MSSICS Screens for SSA-3462.pdf		Yes	Yes	Fillable Fileable Signable
Form	SSA-3462	Record of Supplemental Security Income Inquiry	SSA-3462.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: 1,800,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 98 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,800,000	-334,100	2,134,100
Annual IC Time Burden (Hours)	150,000	-27,842	177,842
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.