Information Collection

Centenarian Project Development Worksheets: Face-to-Face Interview and Telephone Interview

IC 191770 under ICR 201212-0960-004 · OMB 0960-0780.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0780 can be found here:

Documents and Forms

Document Name Document Type
Face to Face Worksheet (revised).pdf Other-Interview Worksheet
Telephone Contact Worksheet(revised).pdf Other-Interview Worksheet
3rd Party Contact Worksheet - Discontinued.pdf Discontinued 3rd Party Worksheet IC Document
Telephone Contact Worksheet.pdf Telephone Contact Worksheet (current) IC Document
Face to Face Worksheet.pdf Face to Face Worksheet (current) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Centenarian Project Development Worksheets: Face-to-Face Interview and Telephone Interview	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 416.204(b) 20 CFR 422.135

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Interview Worksheet			Face to Face Worksheet (revised).pdf		Yes	No	Printable Only
Other-Interview Worksheet			Telephone Contact Worksheet(revised).pdf		Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 22,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	22,000	8,000	14,000
Annual IC Time Burden (Hours)	5,500	2,000	3,500
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Discontinued 3rd Party Worksheet	3rd Party Contact Worksheet - Discontinued.pdf	12/10/2012
Telephone Contact Worksheet (current)	Telephone Contact Worksheet.pdf	03/21/2013
Face to Face Worksheet (current)	Face to Face Worksheet.pdf	03/21/2013

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