Information Collection

Regional Application (NY Debt Management-NYDM)

IC 195877 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⚠️ Notice: This information collection may be referencing outdated material.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-632-BK Request For Waiver Of Overpayment Recovery Regional Application (NY Debt Management-NYDM)	Form
Form SSA-634 Request for Change in Repayment Notice Regional Application (NY Debt Management-NYDM)	Form
DMS Screenshots.docx	Other-DMS Screens
SSA-632-BK - 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-632-BK Request For Waiver Of Overpayment Recovery SSA-632-BK - Revised.pdf	Form
SSA-634 Request for Change in Repayment Notice SSA-634.pdf	Form
SSA-632-BK - Current.pdf SSA-632-BK - Current	IC Document

IC Title:

Regional Application (NY Debt Management-NYDM)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-DMS Screens			DMS Screenshots.docx	Yes	Yes	Fillable Fileable Signable
Form	SSA-632-BK	Request For Waiver Of Overpayment Recovery	SSA-632-BK - Revised.pdf	No		Fillable Printable
Other-Revised PA and PRA Statements			SSA-632-BK - Revised PA & PRA Statements.pdf	No		Fillable Printable
Form	SSA-634	Request for Change in Repayment Notice	SSA-634.pdf	No		Fillable Printable
Other-Revised PA and PRA Statements			SSA-634 - Revised PA & PRA Statements.pdf	No		Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-30,000	30,000
Annual IC Time Burden (Hours)	-60,000	60,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-632-BK - Current	SSA-632-BK - Current.pdf	04/24/2017

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