Information Collection

Statutory Benefit Continuation Election Statement- Hearing Appeal Level: Form

IC 271879 under ICR 202410-0960-021 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-792 Statutory Benefit Continuation Election Statement- Hearing Appeal Level: Form	Form and Instruction
SSA-792 Statutory Benefit Continuation Election Statement SSA-792.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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
Form and Instruction	SSA-792	Statutory Benefit Continuation Election Statement	SSA-792.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: 17,107

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	17,107	17,107
Annual IC Time Burden (Hours)	26,801	26,801
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.