Information Collection

Verification of New Residence

IC 209528 under ICR 201311-0960-012 · OMB 0960-0671.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0671 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
HA-L2 - Revised Version.pdf	Other-Cover Letter

IC Title:

Verification of New Residence

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.1436(d)(1) 20 CFR 404.936(c)(1) 20 CFR 405.317(a)(1)

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
Other-Cover Letter			HA-L2 - Revised Version.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: 45,000

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	Program Change Due to New Statute
Annual Number of Responses for this IC	45,000	45,000
Annual IC Time Burden (Hours)	3,750	3,750
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.