Information Collection

e8508

IC 196447 under ICR 201912-0960-001 · OMB 0960-0133.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0133 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SSA-e8508 Screens.pdf	Other-e8508 Screens
SSA-e8508-DropDownList.pdf	Other-e8508 (dropdown list)
SSA-8508-BK - Revised PA Statement.pdf	Other-Revised Privacy Act Statement

IC Title:

e8508

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-e8508 (dropdown list)	SSA-e8508-DropDownList.pdf	No		Fillable Fileable Signable
Other-e8508 Screens	SSA-e8508 Screens.pdf	Yes	Yes	Fillable Fileable Signable
Other-Revised Privacy Act Statement	SSA-8508-BK - Revised PA Statement.pdf	Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,370

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	4,370	95	4,275
Annual IC Time Burden (Hours)	4,370	95	4,275
Annual IC Cost Burden (Dollars)	0	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.