Information Collection

Ssa-l8553-u3

IC 183772 under ICR 202403-0960-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
SSA-L8553 - Revised.pdf	Other-Notice
SSA-L8553 - Revised.pdf	Other-Notice
SSA-L8553 - Current.pdf SSA-L8553 - Current	IC Document
SSA-L8553 - Current.pdf SSA-L8553 - Current	IC Document

IC Title:

SSA-L8553-U3

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

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
Other-Notice			SSA-L8553 - 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: 4,970

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	4,970	4,970
Annual IC Time Burden (Hours)	1,822	1,822
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-L8553 - Current	SSA-L8553 - Current.pdf	10/06/2020

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