View Information Collection (IC)

View Information Collection (IC)

IC Title:	Successful Worker Sample	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Representative Beneficiary and Successful Worker Combined Questionnaire			Attachment A - NBS Round 8 Instrument.pdf		No		Paper Only
Other-Paper-based NBS Instrument for Experiment			Attachment C - Paper-Based NBS Instrument for Experiment.pdf		No		Paper Only
Other-Respondnet Coorespondence			Attachment D - Respondent Correspondence.pdf		No		Paper Only
Other-c			Attachment E - Confidentiality Pledge.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: 3,000	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

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	3,000	0	3,000	0	0	0
Annual IC Time Burden (Hours)	5,250	0	5,250	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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