Information Collection

eCBSV Enrollment Process

IC 240655 under ICR 202209-0960-002 · OMB 0960-0817.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0817 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form eCBSV User Agreeme eCBSV Enrollment Process	Form and Instruction
Form eCBSV User Agreeme eCBSV User Agreement eCBSV Enrollment Process	Form and Instruction
eCBSV Screen Package.docx	Other-Internet Screens
eCBSV Screen Package.docx	Other-Internet Screens
eCBSV FRN Webpage Language (02-01-2021).docx	Other-eCBSV Website Content
eCBSV FRN Webpage Language (02-01-2021).docx	Other-eCBSV Website Content
EAZE Registration Screens.pdf	Other-EAZE Registration Screens
EAZE Registration Screens.pdf	Other-EAZE Registration Screens
eCBSV User Agreeme eCBSV User Agreement eCBSV User Agreement (6-7-21) - Clean Copy.docx	Form and Instruction
eCBSV User Agreeme eCBSV User Agreement eCBSV User Agreement (6-7-21) - Clean Copy.docx	Form and Instruction
eCBSV User Agreement - Current.pdf Current User Agreement	IC Document
eCBSV User Agreement - Current.pdf Current User Agreement	IC Document
eCBSV User Agreement (6-7-21) - Track Changes.docx eCBSV Revised User Agreement - Track Changes	IC Document
eCBSV User Agreement (6-7-21) - Track Changes.docx eCBSV Revised User Agreement - Track Changes	IC Document

IC Title:

eCBSV Enrollment Process

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 401.100

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
Form and Instruction	eCBSV User Agreement	eCBSV User Agreement	eCBSV User Agreement (6-7-21) - Clean Copy.docx		Yes	Yes	Fillable Fileable Signable
Other-Internet Screens			eCBSV Screen Package.docx	www.ssa.gov	Yes	Yes	Fillable Fileable Signable
Other-eCBSV Website Content			eCBSV FRN Webpage Language (02-01-2021).docx	www.ssa.gov	Yes	No	Printable Only
Other-EAZE Registration Screens			EAZE Registration Screens.pdf		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 113

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	113	113
Annual IC Time Burden (Hours)	226	226
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current User Agreement	eCBSV User Agreement - Current.pdf	03/26/2021
eCBSV Revised User Agreement - Track Changes	eCBSV User Agreement (6-7-21) - Track Changes.docx	06/08/2021

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