eCBSV Applicants – SSA-157 with Certification Statement

Data Exchange Request Form

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0802 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-157 eCBSV Applicants – SSA-157 with Certification Statement Form
eCBSV Instructional Example SSA-157.pdf Instruction
eCBSV 50 Percent RA MOU - FINAL.pdf Other-eCBSV Initial Rollout MOU
SSA-157 Data Exchange Request Form SSA-157 - Current.pdf Form

Information Collection (IC) Details

IC Title:	eCBSV Applicants – SSA-157 with Certification Statement	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-157	Data Exchange Request Form	SSA-157 - Current.pdf	Yes	Yes	Fillable Fileable Signable
Instruction			eCBSV Instructional Example SSA-157.pdf	Yes	Yes	Fillable Fileable Signable
Other-eCBSV Initial Rollout MOU			eCBSV 50 Percent RA MOU - FINAL.pdf	No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	107	107
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.