Information Collection

COVID Screener Questions and Appointment Check-In - Mobile Application

IC 250429 under ICR 202208-0960-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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
VIPr Mobile Check-In Screens - Revised.pdf	Other-Mobile Application Screens
VIPr Mobile Check-In Screens - Revised.pdf	Other-Mobile Application Screens
VIPr Mobile Check-In - New Text Message Screens.pdf	Other-Mobile Application Screens
VIPr Mobile Check-In - New Text Message Screens.pdf	Other-Mobile Application Screens
VIPr Mobile Check-In Screens - Current.pdf VIPr Mobile Check-in Screen Package - Current	IC Document
VIPr Mobile Check-In Screens - Current.pdf VIPr Mobile Check-in Screen Package - Current	IC Document

IC Title:

COVID Screener Questions and Appointment Check-In - Mobile Application

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-Mobile Application Screens			VIPr Mobile Check-In Screens - Revised.pdf		Yes	Yes	Fillable Fileable Signable
Other-Mobile Application Screens			VIPr Mobile Check-In - New Text Message Screens.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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	16,554	16,554
Annual IC Time Burden (Hours)	16,278	16,278
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
VIPr Mobile Check-in Screen Package - Current	VIPr Mobile Check-In Screens - Current.pdf	07/13/2022

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