Information Collection

International Direct Deposit

IC 9739 under ICR 201212-0960-009 · OMB 0960-0686.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0686 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-1199-(Canada) International Direct Deposit	Form
SSA-1199-(Canada) Direct Deposit Sign-Up Form (Canada) SSA-1199-Canada - Revised Version.pdf	Form
SSA-1199-(Country) Direct Deposit Sign-Up Form (Name of Country) SSA-1199-(Country) - Revised Version.pdf	Form
SSA-1199-(Country) - Current Version.pdf Current SSA-1199-(Country)	IC Document
SSA-1199-Canada - Current Version.pdf Current SSA-1199-Canada	IC Document

IC Title:

International Direct Deposit

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 31 CFR 210

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	SSA-1199-(Canada)	Direct Deposit Sign-Up Form (Canada)	SSA-1199-Canada - Revised Version.pdf		No		Printable Only
Form	SSA-1199-(Country)	Direct Deposit Sign-Up Form (Name of Country)	SSA-1199-(Country) - Revised Version.pdf		No		Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	417	417
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-1199-(Country)	SSA-1199-(Country) - Current Version.pdf	12/31/2012
Current SSA-1199-Canada	SSA-1199-Canada - Current Version.pdf	12/31/2012

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