Internet Application for Pay.gov - Print or Save

The Department of the Treasury’s Pay.gov Collection Application for Benefit Overpayments

Documents and Forms

Document Name Document Type
Pay.gov - Revised Screens.pdf www.ssa.gov and www.pay.gov Other-Internet Screens
Pay.gov - Current Screens.pdf Current Screens for SSA's Pay.gov IC Document

Information Collection (IC) Details

IC Title:	Internet Application for Pay.gov - Print or Save	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.502 20 CFR 404.501 20 CFR 404.521 20 CFR 404.527

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internet Screens			Pay.gov - Revised Screens.pdf	www.ssa.gov and www.pay.gov	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: 42,700	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	512,400	-4,577,112	5,089,512
Annual IC Time Burden (Hours)	85,400	-762,852	848,252
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current Screens for SSA's Pay.gov	Pay.gov - Current Screens.pdf	11/25/2019

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