Information Collection

Verification of New Residence

IC 209528 under ICR 201611-0960-002 · OMB 0960-0671.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0671 can be found here:

Documents and Forms

Document Name Document Type
HA-L2 - Revised Version.pdf Other-Cover Letter
HA-L2 - Current Version.pdf Currently Approved HA-L2 Cover Letter IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Verification of New Residence	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.936(c)(1) 20 CFR 405.317(a)(1) 20 CFR 416.1436(d)(1)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Cover Letter			HA-L2 - Revised Version.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: 45,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	45,000	45,000
Annual IC Time Burden (Hours)	3,750	3,750
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Currently Approved HA-L2 Cover Letter	HA-L2 - Current Version.pdf	12/24/2014

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