Information Collection

Completing Form SSA-89

IC 181576 under ICR 202507-0960-010 · OMB 0960-0760.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-89 Completing Form SSA-89	Form
Form SSA-89 Authroiztion for the Social Security Administration to Release SSN Verification Completing Form SSA-89	Form
SSA-89 Authroiztion for the Social Security Administration to R SSA-89.pdf	Form
SSA-89 Authroiztion for the Social Security Administration to R SSA-89.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 401.100

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
Form	SSA-89				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: 597,295

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	597,295	-1,902,705	2,500,000
Annual IC Time Burden (Hours)	29,865	-95,135	125,000
Annual IC Cost Burden (Dollars)	0	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.

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