Information Collection

SSA-5666 (Administrators)

IC 211838 under ICR 202607-0960-002 · OMB 0960-0646.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-5666 Request for Administrative Information SSA-5666 (Administrators)	Form and Instruction
Disability Case Development electronic cover letter - Revised.pdf	Other-Cover Letter
Revised PA Statement -SSA-5666-.docx	Other-Revised PA Statement
Revised PA Statement-Disability Case Development- Revised.docx	Other-Revised PA Statement
Disability Case Development - paper cover letter template -Revised.pdf	Other-Cover Letter
SSA-5666 Request for Administrative Information SSA-5666 - revised.pdf	Form and Instruction
SSA-5666 - current.pdf SSA-5666 - Current	IC Document
Disability Case Development electronic cover letter - current.pdf Disability Case Development electronic cover letter-current	IC Document
Disability Case Development - paper cover letter template -current.pdf Disability Case Development-paper cover letter-template-current	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 416.924(a)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-5666	Yes	Yes	Fillable Fileable Signable
Other-Cover Letter		Yes	Yes	Fillable Printable
Other-Revised PA Statement		Yes	Yes	Fillable Fileable Signable
Other-Revised PA Statement		Yes	Yes	Fillable Printable
Other-Cover Letter		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 154,723

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	154,723	63,537	91,186
Annual IC Time Burden (Hours)	116,042	70,449	45,593
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-5666 - Current		07/28/2026
Disability Case Development electronic cover letter-current		07/28/2026
Disability Case Development-paper cover letter-template-current		07/30/2026

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

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