Information Collection

SSA-827 with wet signature(paper version)

IC 9639 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form SSA-827 SSA-827 with wet signature(paper version) Form and Instruction
SSA-827 Authorization To Disclose Information To The Social Secu ssa-827 (revised).pdf www.ssa.gov/online/ssa-827.pdf Form and Instruction
ssa-827 (current).pdf SSA-827 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SSA-827 with wet signature(paper version)	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 (revised).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: 1,441,052	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,441,052	29,616	1,411,436
Annual IC Time Burden (Hours)	240,175	4,936	235,239
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-827	ssa-827 (current).pdf	05/30/2014

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