Information Collection

Data Exchange Request Form - State and Local Governments

IC 215703 under ICR 202605-0960-003 · OMB 0960-0802.

Documents and Forms

Document Name Document Type
Form SSA-157 Data Exchange Request Form Data Exchange Request Form - State and Local Governments Form
Form SSA-157 Data Exchange Request Form Data Exchange Request Form - State and Local Governments Form
SSA-157 Data Exchange Request Form DXRF Screens for SSA-157.pdf Form
SSA-157 Data Exchange Request Form SSA-157 (Current Paper Version).pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Data Exchange Request Form - State and Local Governments	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-157	Data Exchange Request Form	DXRF Screens for SSA-157.pdf		Yes	Yes	Fillable Fileable Signable
Form	SSA-157	Data Exchange Request Form	SSA-157 (Current Paper Version).pdf		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: 139	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	139	139
Annual IC Time Burden (Hours)	1,112	1,112
Annual IC Cost Burden (Dollars)	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.

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