Information Collection

SSA-827 (with electronic signature(adult first person only)

IC 197969 under ICR 201202-0960-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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
eAuthorization EDCS screen shots 062011.pdf	Other-Internal Screens
eauthorization Final i3368 screens 022012 Finals.pdf www.socialsecurity.com	Other-Internet Screens
eAuthorization final i3341 screens 022012 Finals.pdf www.socialsecurity.com	Other-Internet Screens
PA Statement for SSA-827.pdf	Other-Internal Screens
i3368 eAuthorization Screens - Current Version.pdf Currently Approved Version of i3368 eAuthorization Screens	IC Document
i3441 eAuthorization Screens - Current Version.pdf Currently Approved Version of i3441 eAuthorization Screens	IC Document

IC Title:

SSA-827 (with electronic signature(adult first person only)

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 45 CFR 160 & 164

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internet Screens	eauthorization Final i3368 screens 022012 Finals.pdf	www.socialsecurity.com	Yes	Yes	Fillable Fileable Signable
Other-Internet Screens	eAuthorization final i3341 screens 022012 Finals.pdf	www.socialsecurity.com	Yes	Yes	Fillable Fileable Signable
Other-Internal Screens	PA Statement for SSA-827.pdf		Yes	Yes	Fillable Fileable Signable
Other-Internal Screens	eAuthorization EDCS screen shots 062011.pdf		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: 2,530,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	2,530,000	2,530,000
Annual IC Time Burden (Hours)	379,500	379,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Currently Approved Version of i3368 eAuthorization Screens	i3368 eAuthorization Screens - Current Version.pdf	02/03/2012
Currently Approved Version of i3441 eAuthorization Screens	i3441 eAuthorization Screens - Current Version.pdf	02/03/2012

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