Information Collection

Demonstration Project Annual Affirmations Worksheet

IC 46661 under ICR 200909-0960-006 · OMB 0960-0699.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0699 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Demonstration Project Annual Affirmations Worksheet	Form and Instruction
Annual Reaffirmations Page - Online version 01-09-07.doc	Other-Affirmation Collection Web Scr
Annual Affirmations Worksheet Direct Payment Demonstration Project Annual Affirmations Worksheet FINAL 01-09-07.doc	Form and Instruction

IC Title:

Demonstration Project Annual Affirmations Worksheet

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.1745-404.1799 20 CFR 416.1545-416.1599

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	N/A	Annual Affirmations Worksheet	Direct Payment Demonstration Project Annual Affirmations Worksheet FINAL 01-09-07.doc		Yes	No	Fillable Printable
Other-Affirmation Collection Web Screens			Annual Reaffirmations Page - Online version 01-09-07.doc		Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 450

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 70 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-450	450
Annual IC Time Burden (Hours)	-75	75
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.