Information Collection

COVID Screener Questions and Appointment Check-In - Telephone Check-In

IC 250430 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⚠️ Notice: This information collection may be referencing outdated material.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
Express Interviews Pre-Screening Questions - OMB Approved on 12-22-20.docx	Other-Telephone Script
Express Interviews Pre-Screening Questions - OMB Approved on 12-22-20.docx	Other-Telephone Script

IC Title:

COVID Screener Questions and Appointment Check-In - Telephone Check-In

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-Telephone Script			Express Interviews Pre-Screening Questions - OMB Approved on 12-22-20.docx		No		Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,615,540

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	6,615,540	0	6,615,540
Annual IC Time Burden (Hours)	7,056,576	2,646,216	4,410,360
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.