Information Collection

Claimant's Medication, 20 CFR 404.1512, 416.912

IC 43700 under ICR 200902-0960-006 · OMB 0960-0289.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0289 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form HA-4632 Claimant's Medications Claimant's Medication, 20 CFR 404.1512, 416.912	Form
HA-4632 Claimant's Medications HA-4632 final.pdf	Form

IC Title:

Claimant's Medication, 20 CFR 404.1512, 416.912

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 416.912 20 CFR 404.1512

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	HA-4632				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: 20,000

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	20,000	-151,939	171,939
Annual IC Time Burden (Hours)	5,000	-37,985	42,985
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.

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