Information Collection

Internet Sign-Ins

IC 239638 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⚠️ Notice: This information collection may be referencing outdated material.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	Other-Revised PA Statement
Electronic Access Screens - Revised.pdf	Other-Internet Screens
Electronic Access Screens - Current.pdf Electronic Access Screens - Current	IC Document

IC Title:

Internet Sign-Ins

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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		Yes	Yes	Fillable Fileable Signable
Other-Internet Screens			Electronic Access Screens - Revised.pdf		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: 53,459,180

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
Annual Number of Responses for this IC	53,459,180	53,459,180
Annual IC Time Burden (Hours)	890,986	890,986
Annual IC Cost Burden (Dollars)	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.