Information Collection

20 CFR 408.202(d) (SSA-2000-F6)

IC 187937 under ICR 201503-0960-002 · OMB 0960-0615.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-2000 20 CFR 408.202(d) (SSA-2000-F6)	Form
Revised PA Statement - SSA-2000 03-23-15.pdf	Other-Revised Privacy Act Statement
SSA-2000 Application for Special Benefits for World War II Vetera SSA-2000 Revised.pdf	Form
PAS Revised SSA2000 03-23-15.pdf Revised Privacy Act Statement	IC Document
SSA-2000 Current Version.pdf SSA-2000 Current Version	IC Document

IC Title:

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 408.202(d) 20 CFR 408.310-408.315 20 CFR 408.230(a) 20 CFR 408.210 20 CFR 408.305

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-2000	Application for Special Benefits for World War II Veterans	SSA-2000 Revised.pdf		No		Paper Only
Other-Revised Privacy Act Statement			Revised PA Statement - SSA-2000 03-23-15.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: 50

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	50	-50	100
Annual IC Time Burden (Hours)	17	-16	33
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Revised Privacy Act Statement	PAS Revised SSA2000 03-23-15.pdf	04/15/2015
SSA-2000 Current Version	SSA-2000 Current Version.pdf	06/24/2015

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