Information Collection

SSA-827 (with electronic signature(eAuthorization)

IC 197969 under ICR 201404-0960-019 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Medical Release Form 827 EDCS Screens - eAuthorization.pdf	Other-Internal Screens
eauthorization Final i3368 screens 022012 Finals.pdf www.socialsecurity.com	Other-Internet Screens
Medical Release Form 827 Pages - Internet Appeals.pdf www.socialsecurity.com	Other-Internet Screens
eAuthorization final eView screenshots.pdf	Other-Internal Screens

IC Title:

SSA-827 (with electronic signature(eAuthorization)

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-Internal Screens	Medical Release Form 827 EDCS Screens - eAuthorization.pdf		Yes	Yes	Fillable Fileable Signable
Other-Internet Screens	eauthorization Final i3368 screens 022012 Finals.pdf	www.socialsecurity.com	Yes	Yes	Fillable Fileable Signable
Other-Internet Screens	Medical Release Form 827 Pages - Internet Appeals.pdf	www.socialsecurity.com	Yes	Yes	Fillable Fileable Signable
Other-Internal Screens	eAuthorization final eView screenshots.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: 1,922,938

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,922,938	-787,177	2,710,115
Annual IC Time Burden (Hours)	288,441	-118,076	406,517
Annual IC Cost Burden (Dollars)	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.