Information Collection

Eligibility Verification Reports

IC 28274 under ICR 199606-2900-010 · OMB 2900-0101.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0101 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Eligibility Verification Reports	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	21-0511V	No	No
Form	21-0513	No	No
Form	21-0512V	No	No
Form	21-0512S	No	No
Form	21-0551S-1	No	No
Form	21-0513-1	No	No
Form	21-0512S-1	No	No
Form	21-0511S	No	No
Form	21-0511V-1	No	No
Form	21-0512V-1	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 751,315	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	812,500	812,500
Annual IC Time Burden (Hours)	406,250	406,250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

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