SSA-1712 - Notice of Reclamation

Statement of Reclamation Action

Documents and Forms

Document Name Document Type
Form SSA-1712 SSA-1712 - Notice of Reclamation Form and Instruction
SSA-1712 Cover Letter -Notice of Reclamation (Canada Payments Mad SSA-1712 - Revised.pdf Form and Instruction
SSA-1712 CN Cover Letter - Notice of Reclamation (Canada Payment Mad SSA-1712-CN - Revised.pdf Form and Instruction
SSA-1712 - Current.pdf SSA-1712 - Current IC Document
SSA-1712-CN - Current.pdf SSA-1712-CN - Current IC Document

Information Collection (IC) Details

IC Title:	SSA-1712 - Notice of Reclamation	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 31 CFR 210

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-1712	Cover Letter -Notice of Reclamation (Canada Payments Made in USD)	SSA-1712 - Revised.pdf		No		Fillable Printable
Form and Instruction	SSA-1712 CN	Cover Letter - Notice of Reclamation (Canada Payment Made in Canada)	SSA-1712-CN - Revised.pdf		No		Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	8	8
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-1712 - Current	SSA-1712 - Current.pdf	05/16/2018
SSA-1712-CN - Current	SSA-1712-CN - Current.pdf	05/16/2018

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