Demonstration Project Annual Affirmations Worksheet

Non-Attorney Representative Demonstration Project Application

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0699 can be found here:

Documents and Forms

Document Name Document Type
Demonstration Project Annual Affirmations Worksheet Form and Instruction
Annual Reaffirmations Page - Online version 01-09-07.doc Other-Affirmation Collection Web Scr
Annual Affirmations Worksheet Direct Payment Demonstration Project Annual Affirmations Worksheet FINAL 01-09-07.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Demonstration Project Annual Affirmations Worksheet	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.1745-404.1799 20 CFR 416.1545-416.1599

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N/A	Annual Affirmations Worksheet	Direct Payment Demonstration Project Annual Affirmations Worksheet FINAL 01-09-07.doc		Yes	No	Fillable Printable
Other-Affirmation Collection Web Screens			Annual Reaffirmations Page - Online version 01-09-07.doc		Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 450	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 70 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-450	450
Annual IC Time Burden (Hours)	-75	75
Annual IC Cost Burden (Dollars)	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.