Information Collection

You Can Make Your Payment by Credit Card--Electronic Application SSA-4589

IC 187022 under ICR 201710-0960-003 · OMB 0960-0462.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0462 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SSA-4589 (revised).pdf	Other-Internal Use Screens
SSA-4588_Interview Screen_Shot (current).pdf SSA-4589 Screen Shot Interview Current Version	IC Document

IC Title:

You Can Make Your Payment by Credit Card--Electronic Application SSA-4589

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.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internal Use Screens			SSA-4589 (revised).pdf		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 258,500

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	258,500	37,184	221,316
Annual IC Time Burden (Hours)	21,542	3,099	18,443
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-4589 Screen Shot Interview Current Version	SSA-4588_Interview Screen_Shot (current).pdf	01/23/2018

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