Information Collection

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

IC 45121 under ICR 201809-0960-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 401.100(a) & (b)

Information Collection 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 %

	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

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.