Information Collection

Ssa-l9790

IC 195826 under ICR 202009-0960-010 · OMB 0960-0369.

Documents and Forms

Document Name Document Type
Form SSA-L9790 SSA-L9790 Form and Instruction
SSA-L9790 Retirement, Survivors and Disability Insurance: Nonwork SSA-9790 - Revised Version.pdf Form and Instruction
SSA-9790 - Current Version.pdf Current SSA-9790 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SSA-L9790	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.452-404.455

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-L9790	Retirement, Survivors and Disability Insurance: Nonwork Months Form	SSA-9790 - Revised Version.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 45,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	45,000	45,000
Annual IC Time Burden (Hours)	7,500	7,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSA-9790	SSA-9790 - Current Version.pdf	12/08/2020

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