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

Application for a Social Security Card

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Express Interviews Pre-Screening Questions - Revised.pdf Other-Telephone Script
Express Interviews Pre-Screening Questions - Revised.pdf Other-Telephone Script
Express Interviews Pre-Screening Questions - Current.pdf Express Interviews Pre-Screening Questions - Current IC Document
Express Interviews Pre-Screening Questions - Current.pdf Express Interviews Pre-Screening Questions - Current IC Document

Information Collection (IC) Details

IC Title:	COVID Screener Questions and Appointment Check-In - Telephone Check-In	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 422.103 - 422.110

Information Collection 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 - Revised.pdf		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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	6,615,540	6,615,540
Annual IC Time Burden (Hours)	7,056,576	7,056,576
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Express Interviews Pre-Screening Questions - Current	Express Interviews Pre-Screening Questions - Current.pdf	03/31/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.