Information Collection

Storing Consent Forms

IC 181574 under ICR 201407-0960-013 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

IC Title:

Storing Consent Forms

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 401.100

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
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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	22,590	22,590
Annual IC Time Burden (Hours)	22,590	22,590
Annual IC Cost Burden (Dollars)	27,000	27,000

Documents for IC

table that charts IC Documents
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.