Information Collection

Connect Direct Transmission of MER Information (subset of "MER Samples" category)

IC 179021 under ICR 201103-0960-011 · OMB 0960-0555.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0555 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0960-0555 sample MER forms.pdf	Other-Sample MER Information (same a

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Connect Direct Transmission of MER Information (subset of "MER Samples" category)

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 416.1024 20 CFR 404.1519 20 CFR 404.1613 20 CFR 404.1614 20 CFR 404.1624 20 CFR 416.903a 20 CFR 416.912 20 CFR 416.913 20 CFR 416.914 20 CFR 416.917 20 CFR 416.919 20 CFR 416.1013 20 CFR 416.1014 20 CFR 404.1503a 20 CFR 404.1513 20 CFR 404.1514 20 CFR 404.1512 20 CFR 404.1517

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-Sample MER Information (same as previous IC, submitted through electronic Connect Direct system)			0960-0555 sample MER forms.pdf	Not through SSA website; sent directly	Yes	Yes	Fillable Fileable Signable

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 218,400

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-218,400	218,400
Annual IC Time Burden (Hours)	-54,600	54,600
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.