Information Collection

YTD--Baseline Questionnaire

IC 9741 under ICR 201201-0960-003 · OMB 0960-0687.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Baseline Questionnaire.pdf	Other-Survey
Baseline Pre-Notification Letter.pdf	Other-Notification Letter

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Voluntary

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
Other-Survey			Baseline Questionnaire.pdf		Yes	Yes	Fillable Fileable
Other-Notification Letter			Baseline Pre-Notification Letter.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: 1,895

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	-1,895	1,895
Annual IC Time Burden (Hours)	-1,042	1,042
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.