Information Collection

Ssa-9303

IC 179409 under ICR 202306-0960-003 · OMB 0960-0707.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0707 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-9303 Notice of Appointment - Please Call Reviewer (Revised) SSA-9303	Form and Instruction
SSA-9304 (current version).pdf	Instruction
SSA-9303 Notice of Appointment - Please Call Reviewer (Revised) SSA-9303 (revised version).pdf	Form and Instruction
SSA-9303 (current version).pdf Current SSA-9303	IC Document

IC Title:

SSA-9303

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 418.(b)(5)

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
Instruction			SSA-9304 (current version).pdf		No		Paper Only
Form and Instruction	SSA-9303	Notice of Appointment - Please Call Reviewer (Revised)	SSA-9303 (revised version).pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 350

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	350	350
Annual IC Time Burden (Hours)	88	88
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-9303	SSA-9303 (current version).pdf	07/14/2023

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