Electronic Records Express Third-Party Registration and Request Screens

Electronic Records Express Third-Party

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0767 can be found here:

Documents and Forms

Document Name Document Type
Appointed Representative ERE Screens - 2017.pdf www.ssa.gov/representation/ Other-Screen Shots
Appointed Representative ERE Screens - 2014.pdf Current ERE Third Party Screens IC Document

Information Collection (IC) Details

IC Title:	Electronic Records Express Third-Party Registration and Request Screens	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screen Shots			Appointed Representative ERE Screens - 2017.pdf	http://www.ssa.gov/representation/	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: 10,413	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,321,747	-50,253	3,372,000
Annual IC Time Burden (Hours)	55,362	-838	56,200
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current ERE Third Party Screens	Appointed Representative ERE Screens - 2014.pdf	09/15/2017

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