SSA-1713/Not-For-Profit

Statement of Reclamation Action

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0734 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-1713 SSA-1713/Not-For-Profit Form
Revised PA Statement SSA-1712-SSA-1713.pdf Other-Revised Privacy Act Statement
SSA-1713 Statement of Reclamation Action SSA-1713 Revised Version.pdf Form
SSA-1712 Cover Letter - Statement of Reclamation Action SSA-1712 Revised Version.pdf Form and Instruction
SSA-1712-CN Cover Letter CN - Statement of Reclamation Action SSA-1712CN Revised Version.pdf Form and Instruction
Revised PA Statement SSA-1712-SSA-1713.pdf Revised Privacy Act Statement SSA-1713, SSA-1712 IC Document
SSA-1713 Current Version.pdf SSA-1713 Current Version IC Document
SSA-1712 Current Version.pdf SSA-1712 Current Version IC Document
SSA-1712CN Current Version.pdf SSA-1712CN Current Version IC Document

Information Collection (IC) Details

IC Title:	SSA-1713/Not-For-Profit	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 31 CFR 210

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	SSA-1713	Statement of Reclamation Action	SSA-1713 Revised Version.pdf	No	Paper Only
Form and Instruction	SSA-1712	Cover Letter - Statement of Reclamation Action	SSA-1712 Revised Version.pdf	No	Paper Only
Form and Instruction	SSA-1712-CN	Cover Letter CN - Statement of Reclamation Action	SSA-1712CN Revised Version.pdf	No	Paper Only
Other-Revised Privacy Act Statement			Revised PA Statement SSA-1712-SSA-1713.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: 7	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	7	7
Annual IC Time Burden (Hours)	0	0
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Revised Privacy Act Statement SSA-1713, SSA-1712	Revised PA Statement SSA-1712-SSA-1713.pdf	04/07/2015
SSA-1713 Current Version	SSA-1713 Current Version.pdf	04/07/2015
SSA-1712 Current Version	SSA-1712 Current Version.pdf	04/07/2015
SSA-1712CN Current Version	SSA-1712CN Current Version.pdf	04/07/2015

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