Information Collection

SSA-2930-BK (Abbreviated Information Requested per FY 2012 Study)

IC 200775 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form SSA-2930-BK SSA-2930-BK (Abbreviated Information Requested per FY 2012 Study) Form and Instruction
SSA-2930-BK RSI/DI Quality Review SSA-2930-BK.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SSA-2930-BK (Abbreviated Information Requested per FY 2012 Study)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-2930-BK	RSI/DI Quality Review	SSA-2930-BK.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: 1,000	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
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	83	83
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.