Information Collection

Response to Notice of Revised Determination

IC 9225 under ICR 201510-0960-005 · OMB 0960-0347.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0347 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-765 Response to Notice of Revised Determination	Form and Instruction
SSA-765 Response to Notice of Revised Determination SSA-765.pdf	Form and Instruction

IC Title:

Response to Notice of Revised Determination

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 416.1492(d) 20 CFR 404.992(b) 20 CFR 404.913-.914 20 CFR 416.1413-.1414

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 and Instruction	SSA-765	Response to Notice of Revised Determination	SSA-765.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: 1,925

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	1,925	1,925
Annual IC Time Burden (Hours)	963	963
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.