Information Collection

eCBSV Enrollment Process

IC 240655 under ICR 202402-0960-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form eCBSV User Agreeme eCBSV Enrollment Process Form and Instruction
eCBSV Screen Package.docx www.ssa.gov Other-Internet Screens
eCBSV Screen Package.docx www.ssa.gov Other-Internet Screens
eCBSV FRN Webpage Language (02-01-2021).docx www.ssa.gov Other-eCBSV Website Content
eCBSV FRN Webpage Language (02-01-2021).docx www.ssa.gov 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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	eCBSV Enrollment Process	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 401.100

Information Collection 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 %

	Change Due to Adjustment in Agency Estimate	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

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.