Information Collection

SSA-632 - Request for Waiver of Overpayment Recovery

IC 8941 under ICR 201904-0960-015 · OMB 0960-0037.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0037 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-632-BK SSA-632 - Request for Waiver of Overpayment Recovery	Form
SSA-632-BK - Revised PA & PRA Statements.pdf	Other-Revised PA and PRA Statements
Waivers Screen Package.pdf	Other-Electronic Waiver Application
SSA-632-BK Request to Waiver of Overpayment Recovery SSA-632-BK - Revised.pdf	Form
SSA-632-BK - Current.pdf SSA-632-BK - Current	IC Document

IC Title:

SSA-632 - Request for Waiver of Overpayment Recovery

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 416.572 20 CFR 404.502-404.513 20 CFR 404.515 20 CFR 416.550-416.570 20 CFR 416.581 20 CFR 422.310 20 CFR 404.520-404.521

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-632-BK	Request to Waiver of Overpayment Recovery	SSA-632-BK - Revised.pdf	No		Fillable Printable
Other-Revised PA and PRA Statements			SSA-632-BK - Revised PA & PRA Statements.pdf	No		Fillable Printable
Other-Electronic Waiver Application Screens			Waivers Screen Package.pdf	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 400,000

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	400,000	400,000
Annual IC Time Burden (Hours)	800,000	800,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-632-BK - Current	SSA-632-BK - Current.pdf	04/24/2017

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