Information Collection

Internet SSA-1699

IC 189771 under ICR 201002-0960-003 · OMB 0960-0732.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0732 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Revised SSA-1699 screen shots.doc www.socialsecurity.gov	Other-screen shots for online applic
Current 1699 screens.doc Current SSA-1699 screens	IC Document

IC Title:

Internet SSA-1699

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-screen shots for online application			Revised SSA-1699 screen shots.doc	http://www.socialsecurity.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 13,200

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-13,200	13,200
Annual IC Time Burden (Hours)	-4,840	4,840
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-1699 screens	Current 1699 screens.doc	06/30/2009

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