SSA-1713 - Statement of Reclamation Action

Statement of Reclamation Action

Documents and Forms

Document Name Document Type
Form SSA-1713 SSA-1713 - Statement of Reclamation Action Form
SSA-1713 Statement of Reclamation Action SSA-1713 - Revised.pdf Form
SSA-1713 - Current.pdf SSA-1713 - Current IC Document

Information Collection (IC) Details

IC Title:	SSA-1713 - Statement of Reclamation Action	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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-1713	Statement of Reclamation Action	SSA-1713 - Revised.pdf		No		Fillable Printable

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	7	0	7
Annual IC Time Burden (Hours)	1	1	0
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-1713 - Current	SSA-1713 - Current.pdf	05/16/2018

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