Important Information About Your Appeal, Waiver Rights, and Repayment Options (Paper Form)

Important Information About Your Appeal, Waiver Rights and Repayment Options

OMB: 0960-0779

IC ID: 191893

Information Collection (IC) Details

View Information Collection (IC)

Important Information About Your Appeal, Waiver Rights, and Repayment Options (Paper Form)
 
No Modified
 
Voluntary
 
20 CFR 404.502 - 404.521

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-3105 Important Information About Your Appeal, Waiver Rights, and Repayment Options ssa-3105(revised).pdf No   Paper Only

Income Security General Retirement and Disability

 

600,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 600,000 0 0 0 0 600,000
Annual IC Time Burden (Hours) 150,000 0 0 0 0 150,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-3105 Current Version ssa-3105(current).pdf 10/15/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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