Information Collection

Pre-1957 Military Service Federal Questionnaire

IC 9093 under ICR 201810-0960-004 · OMB 0960-0120.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0120 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-2512 Pre-1957 Military Service Federal Questionnaire	Form
Revised PA Statement.pdf	Other-Revised PA Statement
SSA-2512 Pre-1957 Military Service--Federal Benefit Questionnaire SSA-2512 - Revised.pdf	Form
SSA-2512 - Current.pdf Current SSA-2512	IC Document

IC Title:

Pre-1957 Military Service Federal Questionnaire

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.1301-404.1371

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-2512	Pre-1957 Military Service--Federal Benefit Questionnaire	SSA-2512 - Revised.pdf		No		Fillable Printable
Other-Revised PA Statement			Revised PA Statement.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: 5,000

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	5,000	5,000
Annual IC Time Burden (Hours)	833	833
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-2512	SSA-2512 - Current.pdf	12/18/2018

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