OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Statement of Funds You Provided to Another, Statement of Funds You Received

IC 9375 under ICR 200811-0960-006 · OMB 0960-0481.

Documents and Forms
Document Name
Document Type
Form
Form
Form
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Statement of Funds You Provided to Another, Statement of Funds You Received
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 416.1103(f)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-2855 Statement of Funds You Received SSA 2855 revised.pdf No   Paper Only
Form SSA-2854 Statement of Funds You Provided To Another SSA 2854 Mark-Up revised.pdf No   Paper Only

Income Security General Retirement and Disability

 

40,000 0
   
Individuals or Households
 
   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 40,000 0 0 0 0 40,000
Annual IC Time Burden (Hours) 6,667 0 0 0 0 6,667
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-2854 Statement of Funds You Provide to Another (Original) Original SSA-2854.pdf 04/29/2009
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.