L106, Letter to Custodian of School Records (Local/State/Tribal Government)

Letter to Custodian of Birth Records

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0693 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-L106 L106, Letter to Custodian of School Records (Local/State/Tribal Government) Form
Revised Privacy Act Statement - 0693.pdf Other-Revised PA Statement
SSA-L106 Letter to Custodian of Birth Records SSA-L106-F3 - Revised.pdf Form
SSA-L106-F3 - Current.pdf SSA-L106-F3 - Current IC Document

Information Collection (IC) Details

IC Title:	L106, Letter to Custodian of School Records (Local/State/Tribal Government)	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 416.802 20 CFR 404.704 20 CFR 404.716 20 CFR 422.107

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-L106	Letter to Custodian of Birth Records	SSA-L106-F3 - Revised.pdf		No		Paper Only
Other-Revised PA Statement			Revised Privacy Act Statement - 0693.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: 1,800	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,800	1,800
Annual IC Time Burden (Hours)	300	300
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-L106-F3 - Current	SSA-L106-F3 - Current.pdf	07/06/2016

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