SSA-L707 -- State/Local Government

Request for Proof(s) from Custodian of Records

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0766 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-L707 SSA-L707 -- State/Local Government Form
SSA-L707 Request for Proof(s) from Custodian of Records SSA-L707 Revised Version.pdf Form
SSA-L707 Current Version.pdf SSA-L707 Current Version IC Document

Information Collection (IC) Details

IC Title:	SSA-L707 -- State/Local Government	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.704 20 CFR 404.720 20 CFR 404.703 20 CFR 404.721 20 CFR 404.723 20 CFR 404.725 20 CFR 404.728

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-L707	Request for Proof(s) from Custodian of Records	SSA-L707 Revised Version.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 501	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	501	501
Annual IC Time Burden (Hours)	84	84
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-L707 Current Version	SSA-L707 Current Version.pdf	08/19/2013

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