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Federal forms, ICRs, and supporting documents

Information Collection

SSA-5666 (Electronic)

IC 211838 under ICR 202008-0960-016 · OMB 0960-0646.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Other-Revised PA & PRA Statements
Other-Revised PA & PRA Statements
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

SSA-5666 (Electronic)
 
No Modified
 
Voluntary
 
20 CFR 416.924(a)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-5666 Request for Administrative Information SSA-5666 - Revised.pdf Yes Yes Fillable Fileable Signable
Other-Revised PA & PRA Statements Revised PA & PRA Statements - SSA-5666.pdf Yes Yes Fillable Fileable Signable

Income Security General Retirement and Disability

 

91,186 0
   
Individuals or Households
 
   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 91,186 0 0 -20,003 0 111,189
Annual IC Time Burden (Hours) 45,593 0 0 -10,002 0 55,595
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-5666 - Current SSA-5666 - Current.pdf 12/03/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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