Information Collection Request

Financial Disclosure for Civil Monetary Penalty (CMP) Debt

ICR 202504-0960-005 · OMB 0960-0776 · Active

Forms and Documents

Document Name	Status
Form SSA-640 Financial Disclosure for Civil Monetary Penalty (CMP) Debt Form and Instruction	Modified
Form SSA-640 Financial Disclosure for Civil Monetary Penalty (CMP) Debt Form and Instruction	Modified
Justification for the Non-Substantive Changes - 0960-0776 (Removal of Signature Requirement).docx Justification for No Material/Nonsubstantive Change	2025-04-28
Justification for the Non-Substantive Changes - 0960-0776 (Removal of Signature Requirement).docx Justification for No Material/Nonsubstantive Change	2025-04-28
Supporting Statement - 0776 (Clean Copy).docx Supporting Statement A	2023-06-13
Supporting Statement - 0776 (Clean Copy).docx Supporting Statement A	2023-06-13

IC Document Collections

IC ID	Document Title	Status
188515	Financial Disclosure for Civil Monetary Penalty (CMP) Debt Form and Instruction	Modified
188515	Financial Disclosure for Civil Monetary Penalty (CMP) Debt Form and Instruction	Modified

ICR Details

Status	Active
Agency/Subagency	SSA
OMB Control No	0960-0776
Type of Information Collection	No material or nonsubstantive change to a currently approved collection
Previous ICR Reference No	202105-0960-002
Date Submitted to OIRA	2025-04-29
Requested Expiration Date	1969-12-31