Information Collection

State Mental Institution Policy Review

IC 9081 under ICR 201311-0960-010 · OMB 0960-0110.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0110 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-9584-BK State Mental Institution Policy Review	Form
SSA-9584-BK State Mental Instintution Policy Review SSA 9584BK(revised).pdf	Form
SSA 9584BK (current).pdf SSA-9584-BK (current version)	IC Document

IC Title:

State Mental Institution Policy Review

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.2035 20 CFR 404.2065 20 CFR 416.635 20 CFR 416.665

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-9584-BK	State Mental Instintution Policy Review	SSA 9584BK(revised).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: 78

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	78	-10	88
Annual IC Time Burden (Hours)	78	-10	88
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-9584-BK (current version)	SSA 9584BK (current).pdf	12/23/2013

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