Information Collection

Completing Form SSA-89

IC 181576 under ICR 202407-0960-001 · OMB 0960-0760.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0760 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-89 Completing Form SSA-89 Form
Form SSA-89 Completing Form SSA-89 Form
SSA-89 - Revised PA and PRA Statements.pdf Other-Revised PA & PRA Statements
SSA-89 - Revised PA and PRA Statements.pdf Other-Revised PA & PRA Statements
SSA-89 Authroiztion for the Social Security Administration to R SSA-89 - Revised.pdf Form
SSA-89 Authroiztion for the Social Security Administration to R SSA-89 - Revised.pdf Form
SSA-89 - Current.pdf SSA-89 - Current IC Document
SSA-89 - Current.pdf SSA-89 - Current IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Completing Form SSA-89	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

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	SSA-89	Authroiztion for the Social Security Administration to Release SSN Verification	SSA-89 - Revised.pdf		Yes	No	Fillable Printable
Other-Revised PA & PRA Statements			SSA-89 - Revised PA and PRA Statements.pdf		Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,500,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,500,000	2,500,000
Annual IC Time Burden (Hours)	125,000	125,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-89 - Current	SSA-89 - Current.pdf	03/10/2020

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