Information Collection

SSA-8510 – Title II and Title XVI general evidence (Personal Information Authorization - Intranet Screens)

IC 216304 under ICR 202105-0960-007 · OMB 0960-0801.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0801 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Personal Information Authorization Page Screens.pdf	Other-Intranet Screens
Personal Information Authorization Page Screens.pdf	Other-Intranet Screens

IC Title:

SSA-8510 â Title II and Title XVI general evidence (Personal Information Authorization - Intranet Screens)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.704 20 CFR 404.820 - 404.823 20 CFR 404.1926 20 CFR 404.1926 20 CFR 418.3001

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-Intranet Screens					Yes	Yes	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 192,235

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	192,235	52,090	140,145
Annual IC Time Burden (Hours)	16,020	4,341	11,679
Annual IC Cost Burden (Dollars)	0	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.

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