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
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 Data Elements.docx	Other-Data elements
SSA-4570 Protection and Advocacy for Beneficiaries of Social Secu SSA-4570- (revised).pdf	Form
SSA-4570 Protection and Advocacy for Beneficiaries of Social Secu SSA-4570- (revised).pdf	Form
SSA-4570 (current).pdf Current SSA-4570	IC Document
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
	Approved	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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].