Agreement Between SSA and the Law Enforcement Agency or Source Jurisdiction

Fugitive Felon Computer Matching Agreements

Documents and Forms

Document Name Document Type
Fugitive Felon reporting Screens 05-11-07.pdf Other-Application Screens
PRA Language Fugitive Felon Agreement 05-13-07.doc Fugitive Felon PRA Language Addendum to Agreement IC Document

Information Collection (IC) Details

IC Title:	Agreement Between SSA and the Law Enforcement Agency or Source Jurisdiction	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.471 20 CFR 416.1339

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Application Screens			Fugitive Felon reporting Screens 05-11-07.pdf		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 28	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	196	196
Annual IC Time Burden (Hours)	196	196
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Fugitive Felon PRA Language Addendum to Agreement	PRA Language Fugitive Felon Agreement 05-13-07.doc	05/13/2007

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