Information Collection

SSA-L707 -- State/Local Government

IC 181648 under ICR 201908-0960-007 · OMB 0960-0766.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-L707 SSA-L707 -- State/Local Government	Form
SSA-L707 Request for Proof(s) from Custodian of Records SSA-L707 (revised).pdf	Form
SSA-L707 (current).pdf SSA-L707 Current Version	IC Document

IC Title:

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 404.728 20 CFR 404.704 20 CFR 404.720 20 CFR 404.703 20 CFR 404.721 20 CFR 404.723 20 CFR 404.725

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-L707	Request for Proof(s) from Custodian of Records	SSA-L707 (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: 94

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	94	-407	501
Annual IC Time Burden (Hours)	16	-68	84
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-L707 Current Version	SSA-L707 (current).pdf	10/22/2019

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