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Information Collection

Authorization for SSA to Obtain Account Records From A Financial Institution And Request for Records - e4641 and AFI System

IC 191430 under ICR 201810-0960-017 · OMB 0960-0293.

Documents and Forms
Document Name
Document Type
Other-Electronic Screens
Other-AFI screens
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Authorization for SSA to Obtain Account Records From A Financial Institution And Request for Records - e4641 and AFI System
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 416.200

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Electronic Screens e4641 Screens - Revised.pdf Yes Yes Fillable Fileable Signable
Other-AFI screens AFI Screenshots.pdf No   Fillable Fileable Signable

Income Security General Retirement and Disability

 

15,860,000 0
   
Private Sector Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 15,860,000 0 0 112,500 0 15,747,500
Annual IC Time Burden (Hours) 528,667 0 0 3,750 0 524,917
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
e4641 Screens - Current e4641 Screens - Current.pdf 12/12/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.