Information Collection

International Centenarian Project

IC 191770 under ICR 202603-0960-012 · OMB 0960-0780.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Face-to-Face Interview Worksheet.pdf	Other-Interview Worksheet
MNUP Worksheet Screen Shots.pdf	Other-Interview Worksheet

IC Title:

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 422.135 20 CFR 416.204(b)

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
Other-Interview Worksheet					Yes	No	Printable Only
Other-Interview Worksheet					Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,220

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	4,220	4,026	194
Annual IC Time Burden (Hours)	1,407	1,194	213
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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