Information Collection

Request for Accommodation in Communication Method

IC 192018 under ICR 201406-0960-002 · OMB 0960-0777.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0777 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SSA 9000 - Screen Shots - Revised Version.pdf	Other-Intranet (internal SSA) screen
SSA-9000-F6 Request for Accommodation SSA-9000 F-6 - Revised Version.pdf	Form
SSA 9000 - Screen Shots - Current Version.pdf Current SSA-9000 Intranet Screen Shots	IC Document
SSA-9000 F-6 - Current Version.pdf Current Paper SSA-9000-F6	IC Document

IC Title:

Request for Accommodation in Communication Method

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 85.51

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Intranet (internal SSA) screens			SSA 9000 - Screen Shots - Revised Version.pdf		Yes	Yes	Fillable Fileable Signable
Form	SSA-9000-F6	Request for Accommodation	SSA-9000 F-6 - 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: 1,417

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	1,417	1,417
Annual IC Time Burden (Hours)	472	472
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-9000 Intranet Screen Shots	SSA 9000 - Screen Shots - Current Version.pdf	05/29/2013
Current Paper SSA-9000-F6	SSA-9000 F-6 - Current Version.pdf	05/29/2013

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