OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

You Can Make Your Payment by Credit Card--Electronic Application SSA-4589

IC 187022 under ICR 202012-0960-014 · OMB 0960-0462.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form SSA-4589
You Can Make Your Payment by Credit Card--Electronic Application SSA-4589		 Form
Form SSA-4589
Credit Card Remittance You Can Make Your Payment by Credit Card--Electronic Application SSA-4589		 Form
SSA-4589 Credit Card Remittance
SSA-4589 (Interview Screens) - Revised.pdf 		Form
SSA-4589 Credit Card Remittance
SSA-4589 (Interview Screens) - Revised.pdf 		Form
SSA-4589 (Interview Screens) - Current.pdf
SSA-4589 (Interview Screens) - Current		IC Document
SSA-4589 (Interview Screens) - Current.pdf
SSA-4589 (Interview Screens) - Current		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

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
Form SSA-4589 Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  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 258,500 0 0 0 0 258,500
Annual IC Time Burden (Hours) 21,542 0 0 0 0 21,542
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
SSA-4589 (Interview Screens) - Current 04/28/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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