Information Collection

eCBSV Applicants – SSA-157 with Certification Statement

IC 235841 under ICR 201904-0960-014 · 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⚠️ Notice: This information collection may be referencing outdated material.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 eCBSV Applicants – SSA-157 with Certification Statement	Form
eCBSV Instructional Example SSA-157.pdf	Instruction
eCBSV 50 Percent RA MOU - FINAL.pdf	Other-eCBSV Initial Rollout MOU
SSA-157 Data Exchange Request Form SSA-157 - Current.pdf	Form

IC Title:

eCBSV Applicants â SSA-157 with Certification Statement

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-157	Data Exchange Request Form	SSA-157 - Current.pdf	Yes	Yes	Fillable Fileable Signable
Instruction			eCBSV Instructional Example SSA-157.pdf	Yes	Yes	Fillable Fileable Signable
Other-eCBSV Initial Rollout MOU			eCBSV 50 Percent RA MOU - FINAL.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: 200

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	107	107
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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