Household Survey

Focus Groups and Survey Regarding Pension Benefit Statements

Documents and Forms

Document Name Document Type
Retirement Statement Survey and Experiment 10-6-14.docx Other-Survey Instrument
Survey Instrument Clarifications for OMB Reviewer 5-28-13.docx Survey Instrument Clarifications for OMB Reviewer IC Document
Retirement Statement Survey and Experiment RLSO 10-6-14.docx Survey Instrument RLSO IC Document

Information Collection (IC) Details

IC Title:	Household Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey Instrument			Retirement Statement Survey and Experiment 10-6-14.docx		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: 2,900	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	2,900	2,900
Annual IC Time Burden (Hours)	870	870
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Survey Instrument Clarifications for OMB Reviewer	Survey Instrument Clarifications for OMB Reviewer 5-28-13.docx	05/28/2013
Survey Instrument RLSO	Retirement Statement Survey and Experiment RLSO 10-6-14.docx	10/06/2014

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