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a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a) - SSA-1365 State Agency Ticket Assignment Form
 
No Modified
 
Mandatory
 
20 CFR 411.150(b)(3) 20 CFR 411.140(d)(3) 20 CFR 411.325(a)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-screens Yes Yes Fillable Fileable

Income Security General Retirement and Disability

 

948 0
   
State, Local, and Tribal Governments
 
   100 %

  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 948 0 0 -4,920 0 5,868
Annual IC Time Burden (Hours) 237 0 0 -741 0 978
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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