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Federal forms, ICRs, and supporting documents

Information Collection

Modified Benefit Formula Questionnaire

IC 9252 under ICR 201702-0960-001 · OMB 0960-0395.

Documents and Forms
Document Name
Document Type
Form and Instruction
Other-Internal Screens
Other-Revised Privacy Act Statement
Other-Paperwork Reduction Act Statem
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Modified Benefit Formula Questionnaire
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-150 Modified Benefit Formula Questionnaire ssa-150 (revised).pdf No   Fillable Printable
Other-Internal Screens SSA-150 MCS Screens.pdf Yes Yes Fillable Fileable
Other-Revised Privacy Act Statement 0395 Privacy Act Statement (revised).doc No   Printable Only
Other-Paperwork Reduction Act Statement Revised 0395 PRA (revised).doc No   Printable Only

Income Security General Retirement and Disability

 

90,000 0
   
Individuals or Households
 
   80 %

  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 90,000 0 0 0 0 90,000
Annual IC Time Burden (Hours) 12,000 0 0 0 0 12,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-150 (current) ssa-150 (current).pdf 04/26/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.