Baseline Survey Materials

Accelerated Benefits Demonstration Project

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0747 can be found here:

Documents and Forms

Document Name Document Type
Appendix C.pdf Note: completed by interviewer Other-Survey Script
Appendix D.doc Other-Consent Forms
Appendix A.doc Other-Survey Letter
Appendix B.doc Other-Fact Sheet
0960-0747 revised documents.pdf Revised Materials IC Document

Information Collection (IC) Details

IC Title:	Baseline Survey Materials	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	URL	Available Electronically?	Electronic Capability
Other-Survey Script	Appendix C.pdf	Note: completed by interviewer	No	Paper Only
Other-Consent Forms	Appendix D.doc		No	Paper Only
Other-Survey Letter	Appendix A.doc		No	Paper Only
Other-Fact Sheet	Appendix B.doc		No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 37,812	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	37,812	37,812
Annual IC Time Burden (Hours)	6,572	6,572
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Revised Materials	0960-0747 revised documents.pdf	03/24/2008

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