Information Collection

Ssa-l8553

IC 183772 under ICR 202502-0960-005 · OMB 0960-0189.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SSA-L8553 - Revised Version.pdf	Other-Notice
SSA-L8553 - Revised Version.pdf	Other-Notice
0960-0189 - Updated PA and PRA Statements.pdf	Other-Revised PRA Statement
0960-0189 - Updated PA and PRA Statements.pdf	Other-Revised PRA Statement
SSA-L8553 - Current Version.pdf Current SSA-L8553	IC Document
SSA-L8553 - Current Version.pdf Current SSA-L8553	IC Document

IC Title:

SSA-L8553

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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					No		Paper Only
Other-Revised PRA Statement					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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	4,970	0	4,970
Annual IC Time Burden (Hours)	15,324	13,502	1,822
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-L8553		06/27/2025

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

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