Information Collection

SSA-634 - Request for Change in Repayment Notice

IC 180027 under ICR 202106-0960-008 · OMB 0960-0037.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0037 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-634 SSA-634 - Request for Change in Repayment Notice	Form
Form SSA-634 Request for Change in Repayment Notice SSA-634 - Request for Change in Repayment Notice	Form
SSA-634 - Revised PA & PRA Statements.pdf	Other-Revised PA and PRA Statements
SSA-634 - Revised PA & PRA Statements.pdf	Other-Revised PA and PRA Statements
SSA Internet Instructions for the SSA-632-BK & SSA-634.docx	Other-SSA Internet Instructions for
SSA Internet Instructions for the SSA-632-BK & SSA-634.docx	Other-SSA Internet Instructions for
SSA-634 Request for Change in Repayment Notice SSA-634 - Revised.pdf	Form
SSA-634 Request for Change in Repayment Notice SSA-634 - Revised.pdf	Form
SSA-634 - Current.pdf SSA-634 - Current	IC Document
SSA-634 - Current.pdf SSA-634 - Current	IC Document

IC Title:

SSA-634 - Request for Change in Repayment Notice

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 416.550-416.570 20 CFR 416.572 20 CFR 404.515 20 CFR 404.502-404.513

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-634	Yes	No	Fillable Printable
Other-Revised PA and PRA Statements		Yes	No	Fillable Printable
Other-SSA Internet Instructions for the SSA-632-BK & SSA-634		Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	100,000	100,000
Annual IC Time Burden (Hours)	75,000	75,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-634 - Current		10/20/2021

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

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