Information Collection

Centenarian Project Title XVI Only

IC 191770 under ICR 201811-0960-004 · OMB 0960-0780.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0780 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Face-to-Face Interview Worksheet.pdf	Other-Interview Worksheet
Telephone Interview Worksheet.pdf	Other-Interview Worksheet

IC Title:

Centenarian Project Title XVI Only

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 422.135 20 CFR 416.204(b)

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-Interview Worksheet			Face-to-Face Interview Worksheet.pdf		Yes	No	Printable Only
Other-Interview Worksheet			Telephone Interview Worksheet.pdf		Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 194

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	194	-46	240
Annual IC Time Burden (Hours)	49	-11	60
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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