Information Collection

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

IC 186506 under ICR 202007-0960-004 · OMB 0960-0546.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Sample MOU Used with States.pdf	Other-Sample MOU
Sample MOU Used with States.pdf	Other-Sample MOU
IAR NE Signed Agreement 11-2010.pdf	Other-Sample Signed Agreement
IAR NE Signed Agreement Appendices (no PII) 11-2010.pdf	Other-Sample Signed Agreement Append

IC Title:

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:

table that charts list of instruments
Document Type	Available Electronically?	Electronic Capability
Other-Sample MOU	No	Paper Only
Other-Sample Signed Agreement	No	Printable Only
Other-Sample Signed Agreement Appendecies	No	Printable 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 %

table that charts list of burden
	Approved	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

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.

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