SSA-5665-BK (Electronic)

Teacher Questionnaire; Request for Administrative Information

OMB: 0960-0646

IC ID: 197497

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

SSA-5665-BK (Electronic)
 
No Modified
 
Voluntary
 
20 CFR 416.1103(f)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-5665-BK (Electronic) Teacher Questionnaire SSA-5665-BK - Revised.pdf Yes Yes Fillable Fileable Signable
Other-Revised PA & PRA Statements Revised PA & PRA Statements - SSA-5665-BK.pdf Yes Yes Fillable Fileable Signable

Income Security General Retirement and Disability

 

246,539 0
   
Individuals or Households
 
   98 %

  Requested 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 246,539 0 0 -46,836 0 293,375
Annual IC Time Burden (Hours) 164,359 0 0 -31,224 0 195,583
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-5665-BK - Current SSA-5665-BK - Current.pdf 12/03/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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