Information Collection

f) State Notification to SSA of Deceased Claimant

IC 186512 under ICR 202007-0960-004 · OMB 0960-0546.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
eIAR - Internet Screens (Revised).pdf	Other-Internet Screens
eIAR - Internet Screens (Revised).pdf	Other-Internet Screens
eIAR - Internet Screens (Current).pdf Current eIAR Screens	IC Document
eIAR - Internet Screens (Current).pdf Current eIAR Screens	IC Document

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 416.1920, 416.1922 20 CFR 416.1901-416.1902, 416.1904 20 CFR 416.1906, 416.1908, 416.1910

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					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: 20

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current eIAR Screens		10/06/2020

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

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