Information Collection

f) 20 CFR 411.560 - SSA-1401, Split Payment Situations

IC 190323 under ICR 202101-0960-002 · OMB 0960-0644.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0644 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-1401 f) 20 CFR 411.560 - SSA-1401, Split Payment Situations	Form
Form SSA-1401 Employment Network Split Payment Request Form f) 20 CFR 411.560 - SSA-1401, Split Payment Situations	Form
SSA-1401 - Revised PA & PRA Statements.pdf	Other-Revised PA and PRA Statements
SSA-1401 - Revised PA & PRA Statements.pdf	Other-Revised PA and PRA Statements
SSA-1401 Employment Network Split Payment Request Form SSA-1401 - Revised.pdf	Form
SSA-1401 Employment Network Split Payment Request Form SSA-1401 - Revised.pdf	Form
SSA-1401 - Current.pdf Current SSA-1401	IC Document
SSA-1401 - Current.pdf Current SSA-1401	IC Document

IC Title:

f) 20 CFR 411.560 - SSA-1401, Split Payment Situations

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 411.560

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
Form	SSA-1401	Employment Network Split Payment Request Form	SSA-1401 - Revised.pdf		Yes	No	Printable Only
Other-Revised PA and PRA Statements			SSA-1401 - Revised PA & PRA Statements.pdf		Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

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	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-1401	SSA-1401 - Current.pdf	11/08/2018

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