Information Collection

e8508

IC 196447 under ICR 201403-0960-010 · OMB 0960-0133.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0133 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
e8508 Revised Screens.pdf	Other-e8508
SSA-e8508-DropDownList.pdf	Other-e8508 (dropdown list)
Letter.pdf Letter	IC Document
e8508 screens.pdf e8508 screens (current version)	IC Document

IC Title:

e8508

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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-e8508			e8508 Revised Screens.pdf		Yes	Yes	Fillable Fileable Signable
Other-e8508 (dropdown list)			SSA-e8508-DropDownList.pdf		No		Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,275

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	Previously Approved
Annual Number of Responses for this IC	4,275	4,275
Annual IC Time Burden (Hours)	4,275	4,275
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Letter	Letter.pdf	05/27/2014
e8508 screens (current version)	e8508 screens.pdf	05/27/2014

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