Authorization to Source to Release Information to the Social Security Administration / SSA-827

Authorization to Source to Release Information to the Social Security Administration

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0623 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-827 Authorization to Source to Release Information to the Social Security Administration / SSA-827 Form and Instruction
SSA-827 Authorization To Disclose Information To The Social Secu SSA-827 02-06-07.pdf www.ssa.gov/online/ssa-827.pdf Form and Instruction
2005 SSA-827.pdf Background Material -- Currently Approved SSA-827 IC Document

Information Collection (IC) Details

IC Title:	Authorization to Source to Release Information to the Social Security Administration / SSA-827	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 416.912 20 CFR 404.1512

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-827	Authorization To Disclose Information To The Social Security Administration	SSA-827 02-06-07.pdf	http://www.ssa.gov/online/ssa-827.pdf	Yes	No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,853,928	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,853,928	-11,561,784	15,415,712
Annual IC Time Burden (Hours)	642,321	-1,926,964	2,569,285
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Background Material -- Currently Approved SSA-827	2005 SSA-827.pdf	04/10/2007

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