Information Collection

Tribal Council Coverage Agreement

IC 235112 under ICR 202109-0960-003 · OMB 0960-0812.

Documents and Forms

Document Name Document Type
SSA-177.pdf Other-Indian Tribal Council Coverage
SSA-177.pdf Other-Indian Tribal Council Coverage
SSA-177-OP1.pdf Other-Indian Tribal Council Coverage
SSA-177-OP1.pdf Other-Indian Tribal Council Coverage

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Tribal Council Coverage Agreement	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Indian Tribal Council Coverage Agreement			SSA-177.pdf		No		Printable Only
Other-Indian Tribal Council Coverage Agreement			SSA-177-OP1.pdf		No		Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	12	-88	100
Annual IC Time Burden (Hours)	2	-15	17
Annual IC Cost Burden (Dollars)	0	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.

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