Information Collection

Internet Requestors

IC 197896 under ICR 202109-0960-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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
eAccess Screen Package.pdf www.ssa.gov	Other-Internet Screens
eAccess Screen Package.pdf www.ssa.gov	Other-Internet Screens
OMB Screen Package Internet Screens September 2021 Release.pdf www.ssa.gov	Other-Internet Screens
OMB Screen Package Internet Screens September 2021 Release.pdf www.ssa.gov	Other-Internet Screens

IC Title:

Internet Requestors

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 401.45 42 CFR 402

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-Internet Screens			eAccess Screen Package.pdf	www.ssa.gov	Yes	Yes	Fillable Fileable Signable
Other-Internet Screens			OMB Screen Package Internet Screens September 2021 Release.pdf	www.ssa.gov	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: 6,752,357

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	6,752,357	12,500	6,739,857
Annual IC Time Burden (Hours)	900,314	1,666	898,648
Annual IC Cost Burden (Dollars)	121,542	225	121,317

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.