Information Collection

SSA-L106 Letter to Custodian of School Records (Beneficiary or Claimant Signature)

IC 238008 under ICR 201904-0960-011 · OMB 0960-0693.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0693 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-L106 SSA-L106 Letter to Custodian of School Records (Beneficiary or Claimant Signature)	Form and Instruction
Revised Privacy Act Statment - SSA-L106 and SSA-L706.pdf	Other-Revised Privacy Act Statement
SSA-L106 Letter to Custodian of School Records SSA-L106 - Revised Version.pdf	Form and Instruction
SSA-L106 - Current Version.pdf SSA-L106 - Current Version	IC Document

IC Title:

SSA-L106 Letter to Custodian of School Records (Beneficiary or Claimant Signature)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.704 20 CFR 416.802 20 CFR 404.716 20 CFR 422.107

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 and Instruction	SSA-L106	Letter to Custodian of School Records	SSA-L106 - Revised Version.pdf		No		Fillable Printable
Other-Revised Privacy Act Statement			Revised Privacy Act Statment - SSA-L106 and SSA-L706.pdf		No		Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 32

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
Annual Number of Responses for this IC	32	32
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-L106 - Current Version	SSA-L106 - Current Version.pdf	10/04/2019

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