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SSA-5665-BK (electronic)
Teacher Questionnaire; Request for Administrative Information
OMB: 0960-0646
IC ID: 197497
OMB.report
SSA
OMB 0960-0646
ICR 201304-0960-006
IC 197497
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0646 can be found here:
2020-12-09 - Revision of a currently approved collection
2017-07-03 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
SSA-5665-BK (electronic)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Voluntary
CFR Citation:
20 CFR 416.1103(f)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
388,581
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
97 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
388,581
0
0
0
0
388,581
Annual IC Time Burden (Hours)
259,054
0
0
0
0
259,054
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.