Information Collection

Ssa-9302

IC 179406 under ICR 200812-0960-011 · OMB 0960-0707.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0707 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-9302 SSA-9302	Form and Instruction
SSA-9304 Checklist of Required Information.doc	Instruction
SSA-9302 Notice of Appointment - Reviewer Will Call SSA-9302-Notice of Appointment-Reviewer Will Call.doc	Form and Instruction
SSA-9302.doc Current SSA-9302/9304	IC Document
SSA-9304.doc Current SSA-9304	IC Document

IC Title:

SSA-9302

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 418(b)(5) (To search for a specific CFR, visit the Code of Federal Regulations.)

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-9302	Notice of Appointment - Reviewer Will Call	SSA-9302-Notice of Appointment-Reviewer Will Call.doc		No		Paper Only
Instruction			SSA-9304 Checklist of Required Information.doc		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5,000	-5,000	10,000
Annual IC Time Burden (Hours)	1,250	-1,250	2,500
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-9302/9304	SSA-9302.doc	12/22/2008
Current SSA-9304	SSA-9304.doc	12/22/2008

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