Ha-4633

Claimant's Work Background

OMB: 0960-0300

IC ID: 9205

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

HA-4633
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.1512(a) 20 CFR 404.1520(a)(4) 20 CFR 404.1565(b) 20 CFR 416.912(a) 20 CFR 416.920(a)(4) 20 CFR 416.965(b)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HA-4633 Claimant's Work Background HA-4633 - Revised.pdf No   Printable Only
Other-Revised PA Statement Revised PA Statement.pdf No   Printable Only

Income Security General Retirement and Disability

 

200,000 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 200,000 0 0 0 0 200,000
Annual IC Time Burden (Hours) 50,000 0 0 0 0 50,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
HA-4633 - Current HA-4633 - Current.pdf 03/29/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

© 2024 OMB.report | Privacy Policy