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Summary of Evidence
Summary of Evidence
OMB: 0960-0430
IC ID: 9284
OMB.report
SSA
OMB 0960-0430
ICR 200705-0960-012
IC 9284
( )
Documents and Forms
Document Name
Document Type
Form SSA-887
Summary of Evidence
Form
SSA-887 Summary of Evidence
SSA-887.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Summary of Evidence
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 416.1413(b)
20 CFR 416.1414(a)
20 CFR 416.1407
20 CFR 404.914(a)
20 CFR 404.913(b)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
SSA-887
Summary of Evidence
SSA-887.pdf
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
49,000
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
49,000
0
0
0
0
49,000
Annual IC Time Burden (Hours)
12,250
0
0
0
0
12,250
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
