Information Collection

Request for Change in Repayment Notice

IC 180027 under ICR 201011-0960-011 · OMB 0960-0037.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0037 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-632-BK Request for Change in Repayment Notice Form
SSA-632-BK Request for Waiver of Overpayment Recovery or Change in SSA-632-BK.pdf Form
SSA-632-BK_w_Inst (original).pdf SSA-632-Bk(original) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Request for Change in Repayment Notice	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 404.502-404.513 20 CFR 416.550-416.570 20 CFR 416.572 20 CFR 404.515

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-632-BK	Request for Waiver of Overpayment Recovery or Change in Repayment Notice	SSA-632-BK.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	100,000	0	100,000
Annual IC Time Burden (Hours)	75,000	-8,333	83,333
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-632-Bk(original)	SSA-632-BK_w_Inst (original).pdf	01/06/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.