Information Collection

SSA SF-424 Burden Collection

IC 187903 under ICR 200901-4040-001 · OMB 4040-0004.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 4040-0004 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4040-0004 SSA SF-424 Burden Collection	Form
Instructions for SF424_Rev2.doc	Instruction
4040-0004 SF-424 SF424 mock-up_Rev2.doc	Form

IC Title:

SSA SF-424 Burden Collection

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 2 CFR 215 2 CFR 220 2 CFR 225 2 CFR 230 5 CFR 1320.5(d)(s)

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	4040-0004	SF-424	SF424 mock-up_Rev2.doc		No	No	Printable Only
Instruction			Instructions for SF424_Rev2.doc		No	No	Printable Only

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	667	667
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.