Information Collection

Ssa-l8554-u3

IC 183773 under ICR 202401-0960-001 · OMB 0960-0189.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0189 can be found here:

Documents and Forms

Document Name Document Type
SSA-L8554 - Revised.pdf Other-Notice
SSA-L8554 - Revised.pdf Other-Notice
SSA-L8554 - Current.pdf SSA-L8554 - Current IC Document
SSA-L8554 - Current.pdf SSA-L8554 - Current IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SSA-L8554-U3	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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-Notice			SSA-L8554 - Revised.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: 705	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	705	705
Annual IC Time Burden (Hours)	259	259
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-L8554 - Current	SSA-L8554 - Current.pdf	10/06/2020

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