Information Collection

0960-0579 i3368 (Internet Screens), 401.1560, 404.1565, 416.960, and 416.965

IC 262612 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
i3368 Screenshots (Revised for PRW NPRM).docx www.ssa.gov	Other-Internet Screens
i3368 Screenshots (Revised for PRW NPRM).docx www.ssa.gov	Other-Internet Screens
i3368 Third Party Screenshots (Revised for PRW NPRM).docx www.ssa.gov	Other-Internet Screens
i3368 Third Party Screenshots (Revised for PRW NPRM).docx www.ssa.gov	Other-Internet Screens
i3368 Screenshots (Current).pdf Current i3368 Screens	IC Document
i3368 Screenshots (Current).pdf Current i3368 Screens	IC Document

IC Title:

0960-0579 i3368 (Internet Screens), 401.1560, 404.1565, 416.960, and 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 401.1560 20 CFR 404.1565 20 CFR 416.960 20 CFR 416.965

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-Internet Screens			i3368 Screenshots (Revised for PRW NPRM).docx	www.ssa.gov	Yes	Yes	Fillable Fileable Signable
Other-Internet Screens			i3368 Third Party Screenshots (Revised for PRW NPRM).docx	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: 989,361

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	989,361	989,361
Annual IC Time Burden (Hours)	1,319,148	1,319,148
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current i3368 Screens	i3368 Screenshots (Current).pdf	10/02/2023

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