Information Collection

SSA-1712 - Notice of Reclamation

IC 44357 under ICR 201802-0960-006 · OMB 0960-0734.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-1712 Cover Letter -Notice of Reclamation (Canada Payments Made in USD) SSA-1712 - Notice of Reclamation	Form and Instruction
Form SSA-1712 CN Cover Letter - Notice of Reclamation (Canada Payment Made in Canada) SSA-1712 - Notice of Reclamation	Form and Instruction
SSA-1712 Cover Letter -Notice of Reclamation (Canada Payments Mad SSA-1712 - Revised.pdf	Form and Instruction
SSA-1712 CN Cover Letter - Notice of Reclamation (Canada Payment Mad SSA-1712-CN - Revised.pdf	Form and Instruction
SSA-1712 - Current.pdf SSA-1712 - Current	IC Document
SSA-1712-CN - Current.pdf SSA-1712-CN - Current	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 31 CFR 210

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
Form and Instruction	SSA-1712				No		Fillable Printable
Form and Instruction	SSA-1712 CN				No		Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 8

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	8	8
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-1712 - Current		05/16/2018
SSA-1712-CN - Current		05/16/2018

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

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