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COVID Screener Questions and Appointment Check-In - Telephone Check-In
Application for a Social Security Card
OMB: 0960-0066
IC ID: 250430
OMB.report
SSA
OMB 0960-0066
ICR 202210-0960-005
IC 250430
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0066 can be found here:
2024-07-31 - No material or nonsubstantive change to a currently approved collection
2023-11-21 - Revision of a currently approved collection
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
View Information Collection (IC)
IC Title:
COVID Screener Questions and Appointment Check-In - Telephone Check-In
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Removed
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
Federal Enterprise Architecture Business Reference Module
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
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
0
0
-6,615,540
0
0
6,615,540
Annual IC Time Burden (Hours)
0
0
-7,056,576
0
0
7,056,576
Annual IC Cost Burden (Dollars)
0
0
0
0
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.