Information Collection

Ssa-2930

IC 9153 under ICR 202502-0960-005 · OMB 0960-0189.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-2930 SSA-2930	Form
Form SSA-2930 RSI/DI Quality Review Case Analysis - Sampled Number Holder SSA-2930	Form
SSA-2930 RSI/DI Quality Review Case Analysis - Sampled Number Hol SSA-2930.pdf	Form
SSA-2930 RSI/DI Quality Review Case Analysis - Sampled Number Hol SSA-2930.pdf	Form

IC Title:

SSA-2930

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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	SSA-2930				No		Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,500

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	1,500	0	1,500
Annual IC Time Burden (Hours)	5,250	4,075	1,175
Annual IC Cost Burden (Dollars)	0	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.

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