Information Collection

Electronic Records Express Third-Party Registration and Request Screens

IC 181427 under ICR 201406-0960-009 · OMB 0960-0767.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0767 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appointed Representative ERE Screens - 2014doc.pdf www.ssa.gov/representation/	Other-Screen Shots
Appointed Representative ERE Screens - 2012doc.pdf Current ERE Third Party Screens	IC Document

IC Title:

Electronic Records Express Third-Party Registration and Request Screens

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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-Screen Shots			Appointed Representative ERE Screens - 2014doc.pdf	http://www.ssa.gov/representation/	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: 12,000

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: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,372,000	825,000	2,547,000
Annual IC Time Burden (Hours)	56,200	13,750	42,450
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current ERE Third Party Screens	Appointed Representative ERE Screens - 2012doc.pdf	08/21/2014

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