Information Collection

YTD--Baseline Questionnaire

IC 9741 under ICR 200901-0960-012 · OMB 0960-0687.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0687 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Baseline Questionnaire.pdf	Other-Survey
Baseline Pre-Notification Letter.pdf	Other-Notification Letter

IC Title:

YTD--Baseline Questionnaire

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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-Survey			Baseline Questionnaire.pdf		Yes	Yes	Fillable Fileable
Other-Notification Letter			Baseline Pre-Notification Letter.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: 1,895

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,895	-636	2,531
Annual IC Time Burden (Hours)	1,042	-350	1,392
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.