Information Collection

Preparing Causality Statements

IC 45274 under ICR 202509-0960-002 · OMB 0960-0310.

Documents and Forms

Document Name Document Type
Preparing Causality Statements.pdf Other-Causality Statements
SSA-199 - Portal Screens.pdf Other-Portal Screens

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Preparing Causality Statements	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.2101(a) 20 CFR 416.2221(a) 20 CFR 404.2121(a) 20 CFR 416.2201(a)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Causality Statements			Preparing Causality Statements.pdf		No		Paper Only
Other-Portal Screens			SSA-199 - Portal Screens.pdf		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: 78	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	234	41	193
Annual IC Time Burden (Hours)	390	68	322
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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