Information Collection

Authorization for SSA to Obtain Account Records From A Financial Institution And Request for Records - Financial Institutions (Electronic)

IC 253711 under ICR 202201-0960-009 · OMB 0960-0293.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0293 can be found here:

Documents and Forms

Document Name Document Type
e4641 Screenshots.pdf Other-Electronic Screens
eAFI Screenshots.pdf Other-Electronic Screens

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Authorization for SSA to Obtain Account Records From A Financial Institution And Request for Records - Financial Institutions (Electronic)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.200

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Electronic Screens			e4641 Screenshots.pdf		Yes	Yes	Fillable Fileable Signable
Other-Electronic Screens			eAFI Screenshots.pdf		Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 14,575,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	14,575,000	14,575,000
Annual IC Time Burden (Hours)	485,833	485,833
Annual IC Cost Burden (Dollars)	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.