Consent for Release of Information

ICR 199707-0960-005

OMB: 0960-0567

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
9512 Migrated
ICR Details
0960-0567 199707-0960-005
Historical Active 199612-0960-010
SSA
Consent for Release of Information
Reinstatement without change of a previously approved collection   No
Regular
Approved without change 09/09/1997
Retrieve Notice of Action (NOA) 07/17/1997
  Inventory as of this Action Requested Previously Approved
09/30/2000 09/30/2000
2,200,000 0 0
110,000 0 0
0 0 0

Consent information is required by the Privacy Act of 1974. The information will be used to authorize release of an individual's records to others when a consent form has been provided.

None
None


No

1
IC Title Form No. Form Name
Consent for Release of Information SSA-3288

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,200,000 0 0 2,200,000 0 0
Annual Time Burden (Hours) 110,000 0 0 110,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
07/17/1997


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