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Federal forms, ICRs, and supporting documents

Information Collection

HA-4633 - Electronic Records Express Submissions

IC 243285 under ICR 202007-0960-003 · OMB 0960-0300.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Other-Revised PA and PRA Statements
Other-Revised PA and PRA Statements
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

HA-4633 - Electronic Records Express Submissions
 
No New
 
Required to Obtain or Retain Benefits
 
20 CFR 404.1512(a) 20 CFR 404.1520(a)(4) 20 CFR 404.1565(b) 20 CFR 416.912(a) 20 CFR 416.920(a)(4) 20 CFR 416.965(b)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction HA-4633 Claimant’s Work Background HA-4633 - Revised Version.pdf www.ssa.gov Yes Yes Fillable Fileable Signable
Other-Revised PA and PRA Statements Revised PA and PRA Statements - HA-4633.pdf www.ssa.gov Yes No Printable Only

Income Security General Retirement and Disability

 

157,700 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 157,700 0 0 157,700 0 0
Annual IC Time Burden (Hours) 78,850 0 0 78,850 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current HA-4633 HA-4633 - Current Version.pdf 08/21/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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