Information Collection

Waiver of Advance Designation (Intranet Version)

IC 256631 under ICR 202507-0960-004 · OMB 0960-0814.

Documents and Forms

Document Name Document Type
Advance Designation - Intranet Screen Package.pdf www.ssa.gov Other-Intranet Advance Designation o
Advance Designation - Internet Privacy Act Statement.pdf www.ssa.gov Other-Privacy Act Statement

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Waiver of Advance Designation (Intranet Version)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Other-Intranet Advance Designation of Representative Payee Screens			Advance Designation - Intranet Screen Package.pdf	www.ssa.gov	Yes	Yes	Fillable Fileable Signable
Other-Privacy Act Statement			Advance Designation - Internet Privacy Act Statement.pdf	www.ssa.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,507,403	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,507,403	1,112,910	394,493
Annual IC Time Burden (Hours)	1,758,637	1,390,444	368,193
Annual IC Cost Burden (Dollars)	0	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.

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