Information Collection

SSA-827 with wet signature

IC 9639 under ICR 201106-0960-004 · OMB 0960-0623.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-827 Authorization To Disclose Information To The Social Security Administration SSA-827 with wet signature	Form and Instruction
SSA-827 Authorization To Disclose Information To The Social Secu SSA-827--marked revisions.pdf www.ssa.gov/online/ssa-827.pdf	Form and Instruction

IC Title:

SSA-827 with wet signature

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 404.1512 20 CFR 416.912

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
Form and Instruction	SSA-827			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: 1,591,551

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,591,551	0	-2,530,000	4,121,551
Annual IC Time Burden (Hours)	265,259	1	-421,667	686,925
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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

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