Information Collection

20 CFR 416.903b(c) - Follow-up Notice

IC 281343 under ICR 202607-0960-007 · OMB 0960-0803.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
BBA 812 - Model Response - For Sections 208 or 1632 of the Act.pdf www.ssa.gov	Other-Sample Templlate
BBA 812 - Model Response - For Section 1128 of the Act.pdf www.ssa.gov	Other-Sample Templlate
BBA 812 - Model Response - For Section 1129 of the Act.pdf www.ssa.gov	Other-Sample Templlate
BBA 812 - Fact Sheet - Initial Notice - Current.pdf BBA 812- Paper Fcat Sheet -Current	IC Document
BBA 812 - Internet Fact Sheet Screen Shots - Current.docx Internet Fact Sheet Screen Shots -Current	IC Document
BBA 812 - Follow Up Notice - Current.docx Sample Follow-up BBA 812 Notification Letter-Current	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 416.903b(c) 20 CFR 404.1503b(c)

Information Collection Instruments:

table that charts list of instruments
Document Type	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Sample Templlate	www.ssa.gov	Yes	No	Printable Only
Other-Sample Templlate	www.ssa.gov	Yes	No	Printable Only
Other-Sample Templlate	www.ssa.gov	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: 40

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	40	80	-40
Annual IC Time Burden (Hours)	13	26	-13
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
BBA 812- Paper Fcat Sheet -Current		07/05/2026
Internet Fact Sheet Screen Shots -Current		07/05/2026
Sample Follow-up BBA 812 Notification Letter-Current		07/05/2026

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

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