Information Collection

National Beneficiary Survey -- National Beneficiary Sample

IC 9716 under ICR 200912-0960-004 · OMB 0960-0666.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Advance Letter.doc	Other-Advance Letter to Participants
Proxy Screener.doc	Other-Pre-Survey Screener
National Beneficiary Survey (parts used for ticket participant sample as well).doc	Other-Survey Script

IC Title:

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	Instrument File	URL	Available Electronically?	Electronic Capability
Other-Advance Letter to Participants	Advance Letter.doc	No response required; just needs to be read by participant	No	Paper Only
Other-Pre-Survey Screener	Proxy Screener.doc	Note: Participant does not need to complete; read by contractor	No	Paper Only
Other-Survey Script	National Beneficiary Survey (parts used for ticket participant sample as well).doc	Note: Participant does not need to complete; read by contractor	No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,400

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,400	2,400
Annual IC Time Burden (Hours)	1,800	1,800
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.