Information Collection

Questionnaire About Special Veterans Benefits

IC 189024 under ICR 201303-0960-010 · OMB 0960-0782.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0782 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-2010 Questionnaire About Special Veterans Benefits	Form
SSA-2010 Cover Letter.pdf	Other-Cover Letter
SSA-2010 Cover Letter - No Response.pdf	Other-Cover Letter
SSA-2010 Questionnaire About Special Veterans Benefits SSA 2010 Revised Version.pdf	Form
SSA 2010 Current Version.pdf SSA-2010 Current Version	IC Document

IC Title:

Questionnaire About Special Veterans Benefits

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	SSA-2010	Questionnaire About Special Veterans Benefits	SSA 2010 Revised Version.pdf	No	Paper Only
Other-Cover Letter			SSA-2010 Cover Letter.pdf	No	Paper Only
Other-Cover Letter			SSA-2010 Cover Letter - No Response.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: 1,308

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,308	-1,192	2,500
Annual IC Time Burden (Hours)	436	-397	833
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-2010 Current Version	SSA 2010 Current Version.pdf	04/30/2013

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