Information Collection

Data Exchange Request Form - State and Local Governments

IC 215703 under ICR 201704-0960-004 · OMB 0960-0802.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0802 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-157 Data Exchange Request Form - State and Local Governments Form
Requesting An Electronic Data Exchange With SSA - Revised Language to Include Epidemiological Requests.pdf www.ssa.gov Other-Internet Instructions
Epidemiology Research Request Website - Revised Language.pdf www.ssa.gov Other-Internet Instructions
SSA-157 Data Exchange Request Form SSA-157.pdf Form
PRA Statement for SSA-157 (OMB No 0960-NEW).doc PRA for SSA-157 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Data Exchange Request Form - State and Local Governments	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-157	Data Exchange Request Form	SSA-157.pdf		Yes	Yes	Fillable Fileable Signable
Other-Internet Instructions			Requesting An Electronic Data Exchange With SSA - Revised Language to Include Epidemiological Requests.pdf	www.ssa.gov	Yes	Yes	Printable Only
Other-Internet Instructions			Epidemiology Research Request Website - Revised Language.pdf	www.ssa.gov	Yes	Yes	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 114	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	114	15	99
Annual IC Time Burden (Hours)	57	7	50
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
PRA for SSA-157	PRA Statement for SSA-157 (OMB No 0960-NEW).doc	03/17/2015

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