Information Collection

h) 20 CFR 411.435, 411.615, 411.625 - Dispute Resolutions

IC 184464 under ICR 201204-0960-004 · OMB 0960-0644.

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IC Title:	h) 20 CFR 411.435, 411.615, 411.625 - Dispute Resolutions	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 411.635 20 CFR 411.615 20 CFR 411.435

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2	2
Annual IC Time Burden (Hours)	4	4
Annual IC Cost Burden (Dollars)	0	0

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