View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0960-0395	ICR Reference No: 200112-0960-006
Status: Historical Active	Previous ICR Reference No: 199811-0960-001
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: 01/30/2002
	Date Received in OIRA: 12/05/2001
Terms of Clearance: Approved consistent with memos from SSA dated 1/18 and 1/22/02. It is noted that the form has not been reprinted in hard copy since the last approval date, and therefore the terms of clearance have not been met regarding the instructions explaining what the "REMARKS" section is to be used for. SSA will correct this upon the next reprinting of the hard copy of the form, and will correct this on the electronic version available on the website now.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2005	02/28/2005	02/28/2002
Responses	90,000	0	90,000
Time Burden (Hours)	12,000	0	12,000
Cost Burden (Dollars)	0	0	0

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