OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Ssa-9314

IC 182005 under ICR 202602-0960-007 · OMB 0960-0707.

Documents and Forms
Document Name
Document Type
Form and Instruction
Other-Revised PA Statement
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

SSA-9314
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 418(b)(5)  (To search for a specific CFR, visit the Code of Federal Regulations.)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-9314 Notice of Quality Review Acknowledgement Form for those without Phones (Revised) SSA-9314(revised).pdf No   Paper Only
Other-Revised PA Statement Privacy Act Statement.docx No   Paper Only

Income Security General Retirement and Disability

 

500 0
   
Individuals or Households
 
   0 %

  Requested 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 500 0 0 0 0 500
Annual IC Time Burden (Hours) 125 0 0 0 0 125
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current SSA-9314 SSA-9314(current).pdf 05/24/2026
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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