Information Collection

c) 20 CFR 411.200(b) - SSA-L1377 Request for Certification of Work

IC 201840 under ICR 201204-0960-004 · OMB 0960-0644.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0644 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-L1377 Timely Progress Requirements to Pass Each 12-month Timely Progress Review c) 20 CFR 411.200(b) - SSA-L1377 Request for Certification of Work	Form and Instruction
SSA-L1377 Timely Progress Requirements to Pass Each 12-month Timel SSA-L1377 - Revised Version.pdf	Form and Instruction
SSA-L1377 - Current Version.pdf Curren SSA-L1377	IC Document

IC Title:

c) 20 CFR 411.200(b) - SSA-L1377 Request for Certification of Work

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 411.200

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 and Instruction	SSA-L1377	Timely Progress Requirements to Pass Each 12-month Timely Progress Review	SSA-L1377 - Revised Version.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: 43,216

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	43,216	43,216
Annual IC Time Burden (Hours)	10,804	10,804
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Curren SSA-L1377	SSA-L1377 - Current Version.pdf	04/05/2012

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