Information Collection

e8508

IC 196447 under ICR 201103-0960-001 · OMB 0960-0133.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0133 can be found here:

Documents and Forms

Document Name Document Type
e8508(new).pdf Other-e8508
SSA-e8508-DropDownList.pdf Other-e8508 (dropdown list)

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	e8508	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-e8508			e8508(new).pdf		Yes	Yes	Fillable Fileable Signable
Other-e8508 (dropdown list)			SSA-e8508-DropDownList.pdf		No		Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,275	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
Annual Number of Responses for this IC	4,275	4,275
Annual IC Time Burden (Hours)	4,275	4,275
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.