Information Collection

SSA-827 with wet signature

IC 9639 under ICR 201305-0960-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form SSA-827 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

Information Collection (IC) Details

View Information Collection (IC)

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:

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--marked revisions.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: 1,411,436	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,411,436	-180,115	1,591,551
Annual IC Time Burden (Hours)	235,239	-30,020	265,259
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.