Information Collection

Certification of Contents of Document(s) or Record(s)

IC 9743 under ICR 201903-0960-010 · OMB 0960-0689.

Documents and Forms

Document Name Document Type
Form SSA-704 Certification of Contents of Document(s) or Record(s) Form
SSA-704 Certification of Contents of Document(s) or Record(s) SSA-704 (revised).pdf Form
SSA-704 (current).pdf SSA-704 Current Version IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Certification of Contents of Document(s) or Record(s)	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 416.1821 20 CFR 404.715 20 CFR 404.725 20 CFR 404.1370-.1371 20 CFR 404.730-.733 20 CFR 404.707 20 CFR 404.720-.721 20 CFR 404.727-.728 20 CFR 408.202 20 CFR 404.723 20 CFR 408.216 20 CFR 404.735

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-704	Certification of Contents of Document(s) or Record(s)	SSA-704 (revised).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: 293	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	293	117	176
Annual IC Time Burden (Hours)	49	20	29
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-704 Current Version	SSA-704 (current).pdf	07/18/2019

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