b) State Submission of Copy of Authorization (Manual Process)

SSI Notice of Interim Assistance Reimbursement (IAR)

Documents and Forms

Document Name Document Type
Sample MOU Used with States.pdf Other-Sample MOU

Information Collection (IC) Details

IC Title:	b) State Submission of Copy of Authorization (Manual Process)	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 416.1901-416.1902, 416.1904 20 CFR 416.1906, 416.1908, 416.1910 20 CFR 416.1920, 416.1922

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Sample MOU			Sample MOU Used with States.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: 27	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	51,138	-17,267	68,405
Annual IC Time Burden (Hours)	2,557	-863	3,420
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.