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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form SSA-L1377 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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.