SSA-634 - Request for Change in Repayment Notice

Request for Waiver of Overpayment Recovery or Change in Repayment Rate

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0037 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-634 SSA-634 - Request for Change in Repayment Notice Form
SSA-634 - Revised PA & PRA Statements.pdf Other-Revised PA and PRA Statements
SSA Internet Instructions for the SSA-632-BK & SSA-634.docx Other-SSA Internet Instructions for
SSA-634 Request for Change in Repayment Notice SSA-634 - Revised.pdf Form
SSA-634 - Current.pdf SSA-634 - Current IC Document

Information Collection (IC) Details

IC Title:	SSA-634 - Request for Change in Repayment Notice	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 416.550-416.570 20 CFR 416.572 20 CFR 404.515 20 CFR 404.502-404.513

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-634	Request for Change in Repayment Notice	SSA-634 - Revised.pdf	Yes	No	Fillable Printable
Other-Revised PA and PRA Statements			SSA-634 - Revised PA & PRA Statements.pdf	Yes	No	Fillable Printable
Other-SSA Internet Instructions for the SSA-632-BK & SSA-634			SSA Internet Instructions for the SSA-632-BK & SSA-634.docx	Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	100,000	100,000
Annual IC Time Burden (Hours)	75,000	75,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-634 - Current	SSA-634 - Current.pdf	10/20/2021

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