Information Collection

Protection and Advocacy for Beneficiaries of Social Security (PABSS)--Grant Awardees

IC 181691 under ICR 202604-0960-009 · OMB 0960-0768.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-4570 Protection and Advocacy for Beneficiaries of Social Security (PABSS) Annual Performance Report Protection and Advocacy for Beneficiaries of Social Security (PABSS)--Grant Awardees	Form
SSA-4570 Data Elements.docx	Other-Data elements
SSA-4570 Protection and Advocacy for Beneficiaries of Social Secu SSA-4570- (revised).pdf	Form
SSA-4570 (current).pdf Current SSA-4570	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 435.51-435.52

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	SSA-4570				Yes	Yes	Fillable Fileable
Other-Data elements					No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1	-56	57
Annual IC Time Burden (Hours)	0	-1,368	1,368
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-4570		04/16/2026

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

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