Information Collection

Ssa-l8554-u3

IC 183773 under ICR 201807-0960-008 · OMB 0960-0189.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0189 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SSA-L8554-U3 - Revised Version.pdf	Other-Notice
SSA-L8554-U3 - Current Version.pdf Current SSA-L8554-U3	IC Document

IC Title:

SSA-L8554-U3

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-Notice			SSA-L8554-U3 - Revised Version.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 705

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	705	705
Annual IC Time Burden (Hours)	59	59
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-L8554-U3	SSA-L8554-U3 - Current Version.pdf	07/20/2018

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