a) State Notification of Receipt of Authorization (Electronic Process)

SSI Notice of Interim Assistance Reimbursement (IAR)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0546 can be found here:

Documents and Forms

Document Name Document Type
eIAR 2 4 Internet Screens for OMB clearance 07-12-11(revised).pptx Other-Internet Screens
Proposed IAR Authorization Screen.ppt Other-Internet Screens
Automated IAR Internet Screens for States.pdf eIAR Internet Screens (current) IC Document

Information Collection (IC) Details

IC Title:	a) State Notification of Receipt of Authorization (Electronic Process)	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 416.1920, 416.1922 20 CFR 416.1901-.1902, 416.1904 20 CFR 416.1906, 416.1908, 416.1910

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internet Screens			eIAR 2 4 Internet Screens for OMB clearance 07-12-11(revised).pptx		Yes	Yes	Fillable Fileable Signable
Other-Internet Screens			Proposed IAR Authorization Screen.ppt		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: 97,330	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	97,330	-86	97,416
Annual IC Time Burden (Hours)	1,622	-2	1,624
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
eIAR Internet Screens (current)	Automated IAR Internet Screens for States.pdf	09/26/2011

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