Information Collection

Fiscal Year (FY) 2021 Prospective Client Survey and FY 21 National Disability Forum

IC 243588 under ICR 201810-0960-002 · OMB 0960-0526.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0526 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
FY 2021 PCS Questionnaire.docx	Other-PCS Questionnaire
FY 2021 Prospective Client Survey Schedule.docx	Other-Prospective Client Survey Sche
Sample 2 - Registration Template - NDF.docx	Other-Registration Template Sample F
Sample 3 - NDF Facilitator and Panelist.docx	Other-NDF Facilitator and Panelist F
Sample 4 - Disability Forum Evaluation Form.docx	Other-Disability Forum Evaluation Fo
Sample 5 - Engage SSA for NDF.docx	Other-Sample Engage SSA for NDF FY 2
Description FY 2021 Prospective Client Survey.docx Description of Fiscal Year (FY) 2021 Prospective Client Survey	IC Document
Description of National Disability Forum FY 2021.docx Description of National Disability Forum FY 2021	IC Document

IC Title:

Fiscal Year (FY) 2021 Prospective Client Survey and FY 21 National Disability Forum

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-PCS Questionnaire	FY 2021 PCS Questionnaire.docx	No		Paper Only
Other-Prospective Client Survey Schedule	FY 2021 Prospective Client Survey Schedule.docx	No		Paper Only
Other-Registration Template Sample FY 21	Sample 2 - Registration Template - NDF.docx	Yes	Yes	Fillable Fileable Signable
Other-NDF Facilitator and Panelist FY 21	Sample 3 - NDF Facilitator and Panelist.docx	No		Paper Only
Other-Disability Forum Evaluation Form FY 21	Sample 4 - Disability Forum Evaluation Form.docx	Yes	Yes	Fillable Fileable Signable
Other-Sample Engage SSA for NDF FY 21	Sample 5 - Engage SSA for NDF.docx	Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,900

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 83 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10,900	10,900
Annual IC Time Burden (Hours)	35,425	35,425
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Description of Fiscal Year (FY) 2021 Prospective Client Survey	Description FY 2021 Prospective Client Survey.docx	09/24/2020
Description of National Disability Forum FY 2021	Description of National Disability Forum FY 2021.docx	09/24/2020

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