Response to Notice of Revised Determination

Response to Notice of Revised Determination 20 CFR 404.913-.914, 404.992(b), 416.1413, 416.1492(d)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0347 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-765 Response to Notice of Revised Determination Form
SSA-765 Response to Notice of Revised Determination ssa765.pdf Form
PRA Generic.doc PRA Statements IC Document

Information Collection (IC) Details

IC Title:	Response to Notice of Revised Determination	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.992(b) 20 CFR 404.913-914 20 CFR 416.1413-1414 20 CFR 416.1492(d)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-765	Response to Notice of Revised Determination	ssa765.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,925	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,925	1,925
Annual IC Time Burden (Hours)	963	963
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
PRA Statements	PRA Generic.doc	03/01/2007

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