View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 0960-0247	ICR Reference No: 200211-0960-007
Status: Historical Active	Previous ICR Reference No: 199910-0960-003
Agency/Subagency: SSA	Agency Tracking No:
Title: Worker's Compensation/Public Disability Benefit Questionnaire - 20 CFR 404.408, Subpart E
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 with change	Conclusion Date: 01/24/2003
	Date Received in OIRA: 11/25/2002
Terms of Clearance: Approved for use through 1/2006 under the condition that SSA updates the PRA disclosure statement to delete the OMB address and to include a current SSA address for public comment.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2006	01/31/2006	01/31/2003
Responses	100,000	0	100,000
Time Burden (Hours)	25,000	0	25,000
Cost Burden (Dollars)	0	0	0

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