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

Authorization for the Social Security Administration to Obtain Personal Information

Documents and Forms

Document Name Document Type
Personal Information Authorization Page Screens.pdf Other-Intranet Screens

Information Collection (IC) Details

IC Title:	SSA-8510 – 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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Intranet Screens			Personal Information Authorization Page Screens.pdf		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 %

	Requested	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

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.