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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form SSA-157 Data Exchange Request Form 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

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:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-157		Yes	Yes	Fillable Fileable Signable
Other-Internet Instructions		www.ssa.gov	Yes	Yes	Printable Only
Other-Internet Instructions		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 %

table that charts list of burden
	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

table that charts IC Documents
Title	Document	Date Uploaded
PRA for SSA-157		03/17/2015

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

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