Claimant's Work Background

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0300 can be found here:

Documents and Forms

Document Name Document Type
Form HA-4633 Claimant's Work Background Form
HA-4633 Claimant's Work Background HA-4633.doc.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Claimant's Work Background	Agency IC Tracking Number:

Is this a Common Form? Yes		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.965(b) 20 CFR 404.1565

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HA-4633	Claimant's Work Background	HA-4633.doc.pdf		Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 151,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	151,000	31,000	120,000
Annual IC Time Burden (Hours)	37,750	7,750	30,000
Annual IC Cost Burden (Dollars)	0	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.