OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Statement of Claimant or Other Person

IC 44220 under ICR 202504-3220-021 · OMB 3220-0183.

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Statement of Claimant or Other Person
 
No Modified
 
Voluntary
 
20 CFR 320 20 CFR 217

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form G-93 (09-18) Statement of Claimant or Other Person Form G-93 (09-18).pdf No   Paper Only

Income Security General Retirement and Disability

RRB-22, Railroad Retirement, Survivor, and Pensioner Benefit System  79 FR 58874

400 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 400 0 0 -900 0 1,300
Annual IC Time Burden (Hours) 100 0 0 -225 0 325
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Statement of Claimant or Other Person SSA-795 (06-2022).pdf 06/18/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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