Information Collection

d. Consent of Release of Records - 20 CFR 401.100(a)&(b) - SSA-3288

IC 45121 under ICR 201512-0960-001 · OMB 0960-0566.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0566 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-3288 d. Consent of Release of Records - 20 CFR 401.100(a)&(b) - SSA-3288	Form and Instruction
SSA-3288 Consent for Release of Information SSA-3288 Mock Up 101615.pdf	Form and Instruction
SSA-3288 (current).pdf Current SSA-3288	IC Document

IC Title:

d. Consent of Release of Records - 20 CFR 401.100(a)&(b) - SSA-3288

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 401.100(a) & (b)

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 and Instruction	SSA-3288	Consent for Release of Information	SSA-3288 Mock Up 101615.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: 3,000,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	3,000,000	3,000,000
Annual IC Time Burden (Hours)	150,000	150,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-3288	SSA-3288 (current).pdf	02/09/2016

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