Information Collection

Credit Card Payment Form

IC 9686 under ICR 201505-0960-007 · OMB 0960-0648.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0648 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-1414 Credit Card Payment Form Form
SSA-1414 Credit Card Payment Form ssa1414 (current).pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Credit Card Payment Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-1414	Credit Card Payment Form	ssa1414 (current).pdf		Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	6,000	6,000
Annual IC Time Burden (Hours)	200	200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.