Information Collection

Protection and Advocacy for Beneficiaries of Social Security (PABSS)--Beneficiaries

IC 182006 under ICR 201007-0960-015 · OMB 0960-0768.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0768 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
PABSS Intake Form (Information from Beneficiaries).pdf	Other-Beneficiaries Intake

IC Title:

Protection and Advocacy for Beneficiaries of Social Security (PABSS)--Beneficiaries

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 435.51-435.52

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-Beneficiaries Intake			PABSS Intake Form (Information from Beneficiaries).pdf		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: 5,000

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	Previously Approved
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	1,250	1,250
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.