OMB control number
Credit Card Payment Form
OMB 0960-0648 ยท SSA.
OMB 0960-0648
SSA uses Form SSA-1414 to process: (1) Credit card payments from former employees and vendors who have outstanding debts owed to the agency; (2) advance payments for reimbursable agreements; and (3) credit card payment for all Freedom of Information Act (FOIA) requests requiring payment. The respondents are former employees, and vendors who have outstanding debts to the agency; entities who have reimbursable agreements with SSA; and individuals who request information through FOIA.
The latest form for Credit Card Payment Form expires 2021-12-31 and is listed under ICR 201807-0960-002.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form SSA-1414 Credit Card Payment Form | Form |
 Addendum - 0648.docx | Supplementary Document |
| Supporting Statement - 0648 (Final).docx | Supporting Statement A |
 Credit Card Payment Form |
Form |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202111-0960-005 | Revision of a currently approved collection | 2021-11-19 | Approved with change | |
| 201807-0960-002 | Revision of a currently approved collection | 2018-10-15 | Approved with change | |
| 201505-0960-007 | Reinstatement without change of a previously approved collection | 2015-07-31 | Approved without change | |
| 201402-0960-010 | No material or nonsubstantive change to a currently approved collection | 2014-03-04 | Approved without change | |
| 201109-0960-003 | Revision of a currently approved collection | 2012-01-13 | Approved without change | |
| 200810-0960-012 | Extension without change of a currently approved collection | 2009-01-30 | Approved without change | |
| 200511-0960-003 | Extension without change of a currently approved collection | 2005-11-17 | Approved with change | |
| 200205-0960-001 | New collection (Request for a new OMB Control Number) | 2002-05-01 | Approved without change |