Information Collection

0960-0300 Ha-4633 (ere) 404.1560; 416.960

IC 262363 under ICR 202404-0960-003 · OMB 0960-0834.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
ERE Screen Package (Current).pdf	Other-Internet Screens
ERE Screen Package (Current).pdf	Other-Internet Screens

IC Title:

0960-0300 HA-4633 (ERE) 404.1560; 416.960

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 404.1560 20 CFR 416.960

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			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: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	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

table that charts IC Documents
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.