Information Collection

Ssa-9313

IC 182004 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⚠️ Notice: This information collection may be referencing outdated material.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-9313 SSA-9313	Form and Instruction
SSA-9313 Notice of Quality Review Acknowledgement Form for those SSA-9313 (revised version).pdf	Form and Instruction
SSA-9313 (current version).pdf Current SSA-9313	IC Document

IC Title:

SSA-9313

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 418(b)(5) (To search for a specific CFR, visit the Code of Federal Regulations.)

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
Form and Instruction	SSA-9313	Notice of Quality Review Acknowledgement Form for those with Phones (Revised)	SSA-9313 (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: 2,500

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	2,500	2,500
Annual IC Time Burden (Hours)	625	625
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-9313	SSA-9313 (current version).pdf	07/14/2023

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