Income Verification

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0518 can be found here:

Documents and Forms

Document Name Document Type
Form 21-0161A Income Verification Form
21-0161A Income Verification 21-0161a.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Income Verification	Agency IC Tracking Number:	2900-0518

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	21-0161A	Income Verification	21-0161a.pdf		No		Printable Only

Line of Business: Income Security

Subfunction: Survivor Compensation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	30,000	30,000
Annual IC Time Burden (Hours)	15,000	15,000
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.