Information Collection

Sections 404.909; 404.910; 404.1740; 416.1409; 416.1410; 416.1540

IC 186685 under ICR 200809-0960-010 · OMB 0960-0774.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SSA-3396P NPRM.pdf	Other-Reg sections

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.910 20 CFR 404.1740 20 CFR 416.1409 20 CFR 416.1410 20 CFR 404.909 20 CFR 416.1540

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
Other-Reg sections				N/A -- regulation sections	Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

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 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	0	0
Annual IC Cost Burden (Dollars)	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.

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