Information Collection

Cost Reimbursable Research Request--Application Reporting

IC 179744 under ICR 201304-0960-003 · OMB 0960-0754.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-9901 Cost Reimbursable Research Request--Application Reporting	Form and Instruction
UsersManual.pdf	Instruction
SSA-9901 HOW TO REQUEST SSA PROGRAM DATA FOR RESEARCH SSA-9901 revised.pdf	Form and Instruction
SSA-9902 Confidentiality Agreement SSA-9902 revised.pdf	Form
SSA-9903 SSA Agreement Regarding Conditions For Use of SSA Data SSA-9903.pdf	Form
SSA-9901.doc SSA-9901(current)	IC Document
SSA-9902.doc SSA-9902(current)	IC Document
SSA-9903.doc SSA-9903	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR Pt. 401.165 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-9901	HOW TO REQUEST SSA PROGRAM DATA FOR RESEARCH	SSA-9901 revised.pdf	Yes	Yes	Fillable Fileable
Form	SSA-9902	Confidentiality Agreement	SSA-9902 revised.pdf	Yes	Yes	Fillable Fileable
Form	SSA-9903	SSA Agreement Regarding Conditions For Use of SSA Data	SSA-9903.pdf	Yes	Yes	Fillable Fileable
Instruction			UsersManual.pdf	Yes	Yes	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 15

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	15	15
Annual IC Time Burden (Hours)	60	60
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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