Information Collection

Storing Consent Forms

IC 181574 under ICR 201312-0960-016 · OMB 0960-0760.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0760 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-89 Storing Consent Forms Form
SSA-89 Authorization for SSA to Release SSN Verification SSA-89 Revised Version.pdf Form
SSA-89 Current Version.doc SSA-89 Current Version IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Storing Consent Forms	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 401.100

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-89	Authorization for SSA to Release SSN Verification	SSA-89 Revised Version.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 90	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: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	22,590	-6,275	28,865
Annual IC Time Burden (Hours)	22,590	-6,275	28,865
Annual IC Cost Burden (Dollars)	27,000	-7,500	34,500

Documents for IC

Title	Document	Date Uploaded
SSA-89 Current Version	SSA-89 Current Version.doc	08/07/2013

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