Information Collection

Request for Accommodation in Communication Method - SSA-9000 & iAccommodate

IC 192018 under ICR 202206-0960-009 · OMB 0960-0777.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0777 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-9000-F6 Request for Accommodation in Communication Method - SSA-9000 & iAccommodate	Form
iAccommodate Intranet Screenshots.pdf	Other-Intranet Screens
iAccommodate Intranet Screenshots.pdf	Other-Intranet Screens
SSA-9000 F-6 - Revised PRA Statement.pdf	Other-Revised PRA Statement
SSA-9000 F-6 - Revised PRA Statement.pdf	Other-Revised PRA Statement
SSA-9000-F6 Request for Accommodation SSA-9000 F-6 - Revised Version.pdf	Form
SSA-9000-F6 Request for Accommodation SSA-9000 F-6 - Revised Version.pdf	Form
SSA-9000 F-6 - Current Version.pdf Current SSA-9000-F6	IC Document
SSA-9000 F-6 - Current Version.pdf Current SSA-9000-F6	IC Document

IC Title:

Request for Accommodation in Communication Method - SSA-9000 & iAccommodate

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 45 CFR 85.51

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-9000-F6	Request for Accommodation	SSA-9000 F-6 - Revised Version.pdf	No		Paper Only
Other-Intranet Screens			iAccommodate Intranet Screenshots.pdf	Yes	Yes	Fillable Fileable Signable
Other-Revised PRA Statement			SSA-9000 F-6 - Revised PRA Statement.pdf	Yes	Yes	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,000

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	5,000	0	5,000
Annual IC Time Burden (Hours)	3,250	1,583	1,667
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-9000-F6	SSA-9000 F-6 - Current Version.pdf	11/04/2022

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