Information Collection Request

Social Security Administration (SSA) COVID-19 Symptoms Screener for Hearings

ICR 202203-0960-014 · OMB 0960-0824 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Justification for Non-Substantive Changes - 0824.docx Justification for No Material/Nonsubstantive Change Uploaded 2022-03-31 Available
Emergency Request Letter - SSA COVID In Person Hearings (12-3-21).docx Supplementary Document Uploaded 2021-12-03 Available
SSA Emergency Supporting Statement COVID Hearings Questionnaire (12-3-21).docx Supporting Statement A Uploaded 2021-12-03 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
250661 COVID Screener Questionnaire Other-Internet Screens Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
06/30/2022 06/30/2022 06/30/2022
179,580 0 179,580
149,650 0 149,650
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
COVID Screener Questionnaire

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 179,580 179,580 0 0 0 0
Annual Time Burden (Hours) 149,650 149,650 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No