View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0960-0395	ICR Reference No: 199811-0960-001
Status: Historical Active	Previous ICR Reference No: 199511-0960-008
Agency/Subagency: SSA	Agency Tracking No:
Title: Modified Benefit Formula Questionnaire
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/08/1999
	Date Received in OIRA: 11/13/1998
Terms of Clearance: SSA is strongly urged to make this form available on its Internet web site. Additionally, when SSA reprints this form, they are to add instructions explaining what the REMARKS section is to be used for.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2002	02/28/2002	01/31/1999
Responses	90,000	0	90,000
Time Burden (Hours)	12,000	0	12,000
Cost Burden (Dollars)	0	0	0

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