Government Pension Questionnaire

Government Pension Questionnaire

OMB: 0960-0160

IC ID: 9142

Documents and Forms
Document Name
Document Type
Form and Instruction
Other-Internal Screens
Other-Revised PA Statement
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Government Pension Questionnaire
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.408a

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-3885 Government Pension Questionnaire SSA-3885 - Revised.pdf No   Printable Only
Other-Internal Screens SSA-3885 - MCS Screens.docx Yes Yes Fillable Fileable Signable
Other-Revised PA Statement Revised PA Statement.pdf No   Printable Only

Income Security General Retirement and Disability

 

76,000 0
   
Individuals or Households
 
   60 %

  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 76,000 0 0 0 0 76,000
Annual IC Time Burden (Hours) 16,467 0 0 0 0 16,467
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-3885 - Current SSA-3885 - Current.pdf 03/13/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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