Information Collection

20 CFR 416.611 (a) (1) and 20 CFR416.11 (a) (1)

IC 9733 under ICR 201209-0960-015 · OMB 0960-0679.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0679 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	20 CFR 416.611 (a) (1) and 20 CFR416.11 (a) (1)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.2011 20 CFR 416.611

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: 250	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	63	63
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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