Information Collection

Health IT Partner Assessment - SSA-680

IC 201618 under ICR 201201-0960-007 · OMB 0960-0798.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0798 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-680 Health IT Partner Assessment - SSA-680	Form
SSA-680 Health IT Partner Assessment SSA-680.xlsx	Form

IC Title:

Health IT Partner Assessment - SSA-680

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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
Form	SSA-680	Health IT Partner Assessment	SSA-680.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	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.