Information Collection

SSA-1713 - Statement of Reclamation Action

IC 44359 under ICR 201802-0960-006 · OMB 0960-0734.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-1713 SSA-1713 - Statement of Reclamation Action	Form
SSA-1713 Statement of Reclamation Action SSA-1713 - Revised.pdf	Form
SSA-1713 - Current.pdf SSA-1713 - 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	SSA-1713	Statement of Reclamation Action	SSA-1713 - Revised.pdf		No		Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 7

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	7	0	7
Annual IC Time Burden (Hours)	1	1	0
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-1713 - Current	SSA-1713 - Current.pdf	05/16/2018

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