Information Collection

Ssa-9311

IC 179411 under ICR 202602-0960-007 · OMB 0960-0707.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-9311 Notice of Appointment-Denial-Reviewer Will Call SSA-9311	Form and Instruction
Privacy Act Statement.docx	Other-Revised PA Statement
SSA-9311 Notice of Appointment-Denial-Reviewer Will Call SSA-9311(revised).pdf	Form and Instruction
SSA-9311(current).pdf SSA-9311	IC Document

IC Title:

SSA-9311

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 418(b)(5) (To search for a specific CFR, visit the Code of Federal Regulations.)

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 and Instruction	SSA-9311				No		Paper Only
Other-Revised PA 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: 450

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	450	450
Annual IC Time Burden (Hours)	113	113
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-9311		05/24/2026

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

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