COVID Screener Questions and Appointment Check-In - Mobile Application

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

Documents and Forms

Document Name Document Type
VIPr Mobile Check-in Screen Package.pdf Other-Mobile Application Screens
VIPr Mobile Check-in Screen Package.pdf Other-Mobile Application Screens

Information Collection (IC) Details

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

Is this a Common Form? No		IC Status: New

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-Mobile Application Screens			VIPr Mobile Check-in 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 %

	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	16,554	16,554
Annual IC Time Burden (Hours)	9,657	9,657
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.