Information Collection

Certification of Contents of Document(s) or Record(s)

IC 9743 under ICR 201212-0960-001 · OMB 0960-0689.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0689 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-704 Certification of Contents of Document(s) or Record(s) Form
SSA-704 Certification of Contents of Document(s) or Record(s) Revised SSA-704.pdf Form
SSA-704 Current Version.pdf SSA-704 Current Version IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Certification of Contents of Document(s) or Record(s)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.715 20 CFR 404.707 20 CFR 404.720-.721 20 CFR 408.202 20 CFR 404.723 20 CFR 404.725 20 CFR 404.727-.728 20 CFR 408.216 20 CFR 404.730-.733 20 CFR 404.735 20 CFR 404.1370-.1371

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-704	Certification of Contents of Document(s) or Record(s)	Revised SSA-704.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: 4,800	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	4,800	4,800
Annual IC Time Burden (Hours)	800	800
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-704 Current Version	SSA-704 Current Version.pdf	01/04/2013

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