Successful Worker Sample

National Beneficiary Survey (Round 8)

Documents and Forms

Document Name Document Type
Attachment A - NBS Round 8 Instrument.pdf Other-Representative Beneficiary and
Attachment A - NBS Round 8 Instrument.pdf Other-Representative Beneficiary and
Attachment C - Paper-Based NBS Instrument for Experiment.pdf Other-Paper-based NBS Instrument for
Attachment C - Paper-Based NBS Instrument for Experiment.pdf Other-Paper-based NBS Instrument for
Attachment D - Respondent Correspondence.pdf Other-Respondnet Coorespondence
Attachment D - Respondent Correspondence.pdf Other-Respondnet Coorespondence
Attachment E - Confidentiality Pledge.pdf Other-c
Attachment E - Confidentiality Pledge.pdf Other-c

Information Collection (IC) Details

IC Title:	Successful Worker Sample	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-Representative Beneficiary and Successful Worker Combined Questionnaire	Attachment A - NBS Round 8 Instrument.pdf	No	Paper Only
Other-Paper-based NBS Instrument for Experiment	Attachment C - Paper-Based NBS Instrument for Experiment.pdf	No	Paper Only
Other-Respondnet Coorespondence	Attachment D - Respondent Correspondence.pdf	No	Paper Only
Other-c	Attachment E - Confidentiality Pledge.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: 3,000	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,000	3,000
Annual IC Time Burden (Hours)	5,250	5,250
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.