Important Information About Your Appeal, Waiver Rights and Repayment Options (Phone Call Leading to SSA Intranet Entry)

Important Information About Your Appeal, Waiver Rights and Repayment Options

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0779 can be found here:

Documents and Forms

Document Name Document Type
DMS Screen.doc Other-Intranet Screens (phone call)

Information Collection (IC) Details

IC Title:	Important Information About Your Appeal, Waiver Rights and Repayment Options (Phone Call Leading to SSA Intranet Entry)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.502-.521

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Intranet Screens (phone call)			DMS Screen.doc		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	200,000	200,000
Annual IC Time Burden (Hours)	50,000	50,000
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.