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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.