Information Collection

Prohibition of Payment of SSI Benefits to Fugitive Felons and Parole/Probation Violators

IC 43706 under ICR 202104-0960-004 · OMB 0960-0617.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0617 can be found here:

Documents and Forms

Document Name Document Type
SSI Claim System Screens - 0617.pdf Other-SSI Claim System Screens
SSI Claim System Screens - 0617.pdf Other-SSI Claim System Screens

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Prohibition of Payment of SSI Benefits to Fugitive Felons and Parole/Probation Violators	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 416.708(o)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-SSI Claim System Screens			SSI Claim System Screens - 0617.pdf		Yes	No	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	17	17
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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