Respondents Who Request an Extract of their SSN Record - Pilot

Application for a Social Security Card

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0066 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-5 Respondents Who Request an Extract of their SSN Record - Pilot Form and Instruction
SSNAP.pdf Other-Internal Screens
SSA-5 Application for a Social Security Card SS-5.pdf Form and Instruction
SS-5-FS Application for a Social Security Card SS-5-FS.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Respondents Who Request an Extract of their SSN Record - Pilot	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 422.103 - 422.110

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-5	Application for a Social Security Card	SS-5.pdf	No		Paper Only
Form and Instruction	SS-5-FS	Application for a Social Security Card	SS-5-FS.pdf	No		Paper Only
Other-Internal Screens			SSNAP.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: 8,130	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-8,130	8,130
Annual IC Time Burden (Hours)	-1,152	1,152
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.