Information Collection

Private Printing and Modification of Prescribed Application and Other Forms

IC 9711 under ICR 201309-0960-003 · OMB 0960-0663.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0663 can be found here:

Documents and Forms

Document Name Document Type
Website Pathing to Instructions.pdf www.socialsecurity.gov Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Private Printing and Modification of Prescribed Application and Other Forms	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 422.527

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Website Pathing to Instructions.pdf	http://www.socialsecurity.gov	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: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 70 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	225	75	150
Annual IC Time Burden (Hours)	30	10	20
Annual IC Cost Burden (Dollars)	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.