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Federal forms, ICRs, and supporting documents

Information Collection

Application and Statement - SSA-3192

IC 9641 under ICR 202007-0960-006 · OMB 0960-0624.

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

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Application and Statement - SSA-3192
 
No Modified
 
Required to Obtain or Retain Benefits
 
41 CFR 102-71.20 41 CFR 102-74.305  (To search for a specific CFR, visit the Code of Federal Regulations.)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-3192 Application and Statement SSA-3192 - Revised (Signable).pdf Yes Yes Fillable Fileable
Other-Revised PRA Statement Revised PRA Statement - SSA-3192.pdf Yes No Fillable Fileable

General Government Central Personnel

 

390 0
   
Individuals or Households
 
   0 %

  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 390 0 0 0 0 390
Annual IC Time Burden (Hours) 195 0 0 0 0 195
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-3192 - Current SSA-3192 - Current.pdf 11/04/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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