View Information Collection (IC)
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Agenda
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ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
f) 20 CFR 411.575 - Requesting EN Payments - SSA-1391; SSA-1398
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Mandatory
CFR Citation:
20 CFR 411.575
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
SSA-1391
Employment Network Payment Request Form
SSA-1391.pdf
No
Paper Only
Form and Instruction
SSA-1389
EN Services Certification Statement (For Use with Phase 1 Milestone 4 Request)
SSA-1389 - Revised.pdf
No
Paper Only
Other-Revised PA and PRA Statements
SSA-1389 - Revised PA & PRA Statements.pdf
No
Paper Only
Other-Revised PA and PRA Statements
SSA-1391 - Revised PA & PRA Statements.pdf
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,704
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
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
1,704
0
0
0
0
1,704
Annual IC Time Burden (Hours)
1,136
0
0
0
0
1,136
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Removed Form SSA-1398
SSA-1398 - Current Version.pdf
01/15/2021
Removed Form SSA-1399
SSA-1399 - Current Version.pdf
01/15/2021
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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