Application for a Social Security Card - with a name change (iSSNRC Internet Modality)

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⚠️ Notice: This information collection may be referencing outdated material.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
ISSNRC OMB Screen Package - Revised.pdf www.ssa.gov Other-Internet Screens
ISSNRC OMB Screen Package - Revised.pdf www.ssa.gov Other-Internet Screens
iSSNRC Internet Screens - Current.pdf Current iSSNRC Screens IC Document
iSSNRC Internet Screens - Current.pdf Current iSSNRC Screens IC Document

Information Collection (IC) Details

IC Title:	Application for a Social Security Card - with a name change (iSSNRC Internet Modality)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 422.103 - 422.110

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internet Screens			ISSNRC OMB Screen Package - Revised.pdf	www.ssa.gov	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: 1,312	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,312	-43,506	44,818
Annual IC Time Burden (Hours)	765	-2,970	3,735
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current iSSNRC Screens	iSSNRC Internet Screens - Current.pdf	02/07/2022

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