Information Collection

Ssa-2931

IC 183264 under ICR 201201-0960-002 · OMB 0960-0189.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0189 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-2931(revised) SSA-2931	Form
SSA-2931(revised) RSI/DI Quality Review Case Analysis - Auxiliaries/Surviv SSA-2931 (revised).doc	Form
SSA-2931 (original).pdf SSA-2391(original)	IC Document

IC Title:

SSA-2931

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation:

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
Form	SSA-2931(revised)	RSI/DI Quality Review Case Analysis - Auxiliaries/Survivors	SSA-2931 (revised).doc		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 750

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	750	750
Annual IC Time Burden (Hours)	375	375
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-2391(original)	SSA-2931 (original).pdf	01/03/2011

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