HA-4633 - Paper Version

Claimant's Work Background

Documents and Forms

Document Name Document Type
Form HA-4633 HA-4633 - Paper Version Form
Revised PA and PRA Statements - HA-4633.pdf Other-Revised PA and PRA Statements
HA-4633 Claimant's Work Background HA-4633 - Revised Version.pdf Form
HA-4633 - Current Version.pdf HA-4633 - Current IC Document

Information Collection (IC) Details

IC Title:	HA-4633 - Paper Version	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 416.912(a) 20 CFR 416.920(a)(4) 20 CFR 416.965(b) 20 CFR 404.1512(a) 20 CFR 404.1520(a)(4) 20 CFR 404.1565(b)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HA-4633	Claimant's Work Background	HA-4633 - Revised Version.pdf		No		Printable Only
Other-Revised PA and PRA Statements			Revised PA and PRA Statements - HA-4633.pdf		No		Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 53,200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	53,200	-146,800	200,000
Annual IC Time Burden (Hours)	13,300	-36,700	50,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
HA-4633 - Current	HA-4633 - Current Version.pdf	08/21/2020

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