SSA-5665-BK (paper)

Teacher Questionnaire; Request for Administrative Information

OMB: 0960-0646

IC ID: 9683

Information Collection (IC) Details

View Information Collection (IC)

SSA-5665-BK (paper)
 
No Modified
 
Voluntary
 
20 CFR 416.924(a)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-5665-BK Teacher Questionnaire SSA-5665-BK Revised Version.pdf No   Paper Only
Other-ODAR Cover Letter ODAR Cover Letter (SSA-5665 Teacher Questionnaire) (2)(Final) (2).docx No   Paper Only

Income Security General Retirement and Disability

 

2,562 0
   
State, Local, and Tribal Governments
 
   0 %

  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 2,562 0 0 -8,857 0 11,419
Annual IC Time Burden (Hours) 1,708 0 0 -5,905 0 7,613
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-5665-BK (Current) ssa-5665 Current Version.pdf 06/11/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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