Information Collection

Internet Requestors

IC 197896 under ICR 202001-0960-007 · OMB 0960-0789.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0789 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Revised PA Statement.pdf www.ssa.gov	Other-Revised PA Statement
Electronic Access Screens - Revised.pdf www.ssa.gov	Other-Internet Screens
Electronic Access Screens - Current.pdf Electronic Access Screens - Current	IC Document

IC Title:

Internet Requestors

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 402 42 CFR 401.45

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-Revised PA Statement			Revised PA Statement.pdf	www.ssa.gov	Yes	Yes	Fillable Fileable Signable
Other-Internet Screens			Electronic Access Screens - Revised.pdf	www.ssa.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,923,048

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	6,923,048	-58,459,420	65,382,468
Annual IC Time Burden (Hours)	923,073	-7,794,589	8,717,662
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Electronic Access Screens - Current	Electronic Access Screens - Current.pdf	01/29/2020

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