Information Collection

COVID Screener Questions and Appointment Check-In - Mobile Application

IC 250429 under ICR 202202-0960-001 · OMB 0960-0066.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0066 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
VIP Mobile OMB screen package.pdf	Other-Mobile Application Screens
VIP Mobile OMB screen package.pdf	Other-Mobile Application Screens

IC Title:

COVID Screener Questions and Appointment Check-In - Mobile Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 422.103 - 422.110

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-Mobile Application Screens			VIP Mobile OMB screen package.pdf		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: 16,554

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	16,554	0	16,554
Annual IC Time Burden (Hours)	16,278	6,621	9,657
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.