Information Collection

Internet Application for Pay.gov - Email Receipt

IC 238692 under ICR 201911-0960-007 · OMB 0960-0811.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Pay.gov - Revised Screens.pdf	Other-Internet Screens

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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

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
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: 18,300

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	219,600	219,600
Annual IC Time Burden (Hours)	40,260	40,260
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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