Information Collection

c. Consent for Release of Records (Electronic SSA-3288-OP1)+

IC 257878 under ICR 202601-0960-008 · OMB 0960-0566.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SSA-3288-OP1 - Revised Version.pdf www.ssa.gov/privacy	Other-Webform Application
CASES OMB Screen Package (revised).pdf www.ssa.gov/privacy	Other-Internet Screens
SSA-3288-APP - Current Version.pdf SSA-3288-OP1: (Webform Application) (current)	IC Document
CASES OMB Screen Package (current).pdf Current CASES Screens	IC Document

IC Title:

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Webform Application				www.ssa.gov/privacy	Yes	Yes	Fillable Fileable Signable
Other-Internet Screens				www.ssa.gov/privacy	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: 1,152

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,152	1,152
Annual IC Time Burden (Hours)	768	768
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-3288-OP1: (Webform Application) (current)		07/22/2025
Current CASES Screens		01/30/2026

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

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