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Federal forms, ICRs, and supporting documents

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f) 20 CFR 411.575 - SSA-1391; SSA-1389

IC 184462 under ICR 202101-0960-002 · OMB 0960-0644.

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

View Information Collection (IC)

f) 20 CFR 411.575 - SSA-1391; SSA-1389
 
No Modified
 
Mandatory
 
20 CFR 411.575

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-1391 Employment Network Payment Request Form SSA-1391 - Revised.pdf No   Paper Only
Form and Instruction SSA-1389 EN Services Certification Statement (For Use with Phase 1 Milestone 4 Request) SSA-1389 - Revised.pdf No   Paper Only
Other-Revised PA and PRA Statements SSA-1389 - Revised PA & PRA Statements.pdf No   Paper Only
Other-Revised PA and PRA Statements SSA-1391 - Revised PA & PRA Statements.pdf No   Paper Only

Income Security General Retirement and Disability

 

2,805 0
   
State, Local, and Tribal Governments
 
   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 2,805 0 0 0 0 2,805
Annual IC Time Burden (Hours) 1,870 0 0 0 0 1,870
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Removed Form SSA-1398 SSA-1398 - Current Version.pdf 01/15/2021
Removed Form SSA-1399 SSA-1399 - Current Version.pdf 01/15/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.