Information Collection

SCE Field Office Interview

IC 212610 under ICR 201707-0960-003 · OMB 0960-0723.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0723 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SSA-1026-SCE - Revised.pdf	Other-Interview Screens
Revised PA Statement.pdf	Other-Revised PA Statement
SSA-1026-SCE - Current.pdf SSA-1026-SCE - Current	IC Document

IC Title:

SCE Field Office Interview

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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
Other-Interview Screens			SSA-1026-SCE - Revised.pdf		Yes	Yes	Fillable Fileable Signable
Other-Revised PA Statement			Revised PA Statement.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,468

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 18 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,468	-486	3,954
Annual IC Time Burden (Hours)	1,040	-146	1,186
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-1026-SCE - Current	SSA-1026-SCE - Current.pdf	09/27/2017

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