Statutory Benefit Continuation Election Statement- Hearing Appeal Level: Form

Statutory Benefit Continuation Election Statement

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Statutory Benefit Continuation Election Statement- Hearing Appeal Level: Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
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 %

	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

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.