CPA Compliance Review and Report

Electronic Consent Based Social Security Number Verification

Documents and Forms

Document Name Document Type
Form eCBSV User Agreeme CPA Compliance Review and Report Form and Instruction
eCBSV Customer Connection Screen Package.docx www.ssa.gov Other-Internet Screens
eCBSV Customer Connection Screen Package.docx www.ssa.gov Other-Internet Screens
eCBSV User Agreeme eCBSV User Agreement eCBSV User Agreement.docx www.ssa.gov Form and Instruction
eCBSV User Agreeme eCBSV User Agreement eCBSV User Agreement.docx www.ssa.gov Form and Instruction

Information Collection (IC) Details

IC Title:	CPA Compliance Review and Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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.docx	www.ssa.gov	Yes	Yes	Fillable Fileable Signable
Other-Internet Screens			eCBSV Customer Connection Screen Package.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: 21	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	21	-92	113
Annual IC Time Burden (Hours)	1,680	-7,360	9,040
Annual IC Cost Burden (Dollars)	0	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.