SSA-INITIATED PERSONAL EARNINGS AND BENEFIT ESTIMATE STATEMENT, PUBLIC OPINION QUESTIONNAIRE (FOLLOWUP)

ICR 199409-0960-005

OMB: 0960-0484

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0960-0484 199409-0960-005
Historical Active 199403-0960-008
SSA
SSA-INITIATED PERSONAL EARNINGS AND BENEFIT ESTIMATE STATEMENT, PUBLIC OPINION QUESTIONNAIRE (FOLLOWUP)
Revision of a currently approved collection   No
Regular
Approved without change 11/22/1994
Retrieve Notice of Action (NOA) 09/12/1994
This information collection is approved through 12/95 under the following conditions: SSA will furnish to OMB a copy of the final report of the 1994 Workload Impact Study as soon as it is available an a copy of the final report of the follow-up study upon its completion.
  Inventory as of this Action Requested Previously Approved
12/31/1995 12/31/1995 10/31/1994
4,500 0 5,000
900 0 1,000
0 0 0

THE INFORMATION ON FORM SSA-7005 WILL BE USED BY THE SOCIAL SECURITY ADMINISTRATION TO OBTAIN RECIPIENT REACTION, OPINION, AND STATEMENT (PEBES). THE RESPONDENTS WILL BE SELECTED RECIPIENTS OF PEBES WHO COMPLETE AND RETURN THIS QUESTIONNAIRE.

None
None


No

1
IC Title Form No. Form Name
SSA-INITIATED PERSONAL EARNINGS AND BENEFIT ESTIMATE STATEMENT, PUBLIC OPINION QUESTIONNAIRE (FOLLOWUP) SSA-7005

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 4,500 5,000 0 -500 0 0
Annual Time Burden (Hours) 900 1,000 0 -100 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
09/12/1994


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