Information Collection

0960-0300 Ha-4633 (ere) 410.1560; 404.1565; 416.960; 416.965

IC 262363 under ICR 202309-0960-005 · OMB 0960-0834.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0834 can be found here:

Documents and Forms

Document Name Document Type
ERE Screen Package (Current).pdf www.ssa.gov Other-Internet Screens
ERE Screen Package (Current).pdf www.ssa.gov Other-Internet Screens

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	0960-0300 HA-4633 (ERE) 410.1560; 404.1565; 416.960; 416.965	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.1565 20 CFR 404.1560 20 CFR 416.960 20 CFR 416.965

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internet Screens			ERE Screen Package (Current).pdf	www.ssa.gov	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: 157,700	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	157,700	157,700
Annual IC Time Burden (Hours)	52,567	52,567
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.