Internet-Based Static or Dynamic Webform (through Upload Documents or CPAS)

Upload Documents (eSubmit)

Documents and Forms

Document Name Document Type
Upload Documents (eSubmit) Screen Package.pdf www.ssa.gov Other-Internet Screens
Upload Documents (eSubmit) Screen Package.pdf www.ssa.gov Other-Internet Screens
Upload Documents Screen Package - Customer Initiated and Credential Step-Up (Revised Screens - 3-20-25).pdf www.ssa.gov Other-Internet Screens
Upload Documents Screen Package - Customer Initiated and Credential Step-Up (Revised Screens - 3-20-25).pdf www.ssa.gov Other-Internet Screens
Upload Documents Dynamic Forms Screen Package - Sample (SSA 4162).pdf www.ssa.gov (mySocial Security Account) Other-Dynamic Pathing Internet Scree
Upload Documents Dynamic Forms Screen Package - Sample (SSA 4162).pdf www.ssa.gov (mySocial Security Account) Other-Dynamic Pathing Internet Scree
Upload Documents - Revised Privacy Act Statement.pdf www.ssa.gov Other-Revised Privacy Act Statement
Upload Documents - Revised Privacy Act Statement.pdf www.ssa.gov Other-Revised Privacy Act Statement

Information Collection (IC) Details

IC Title:	Internet-Based Static or Dynamic Webform (through Upload Documents or CPAS)	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 404.704 20 CFR 422.505 20 CFR 404.1512 20 CFR 416.200 20 CFR 416.912

Information Collection Instruments:

Document Type	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internet Screens	Upload Documents (eSubmit) Screen Package.pdf	www.ssa.gov	Yes	Yes	Fillable Fileable Signable
Other-Internet Screens	Upload Documents Screen Package - Customer Initiated and Credential Step-Up (Revised Screens - 3-20-25).pdf	www.ssa.gov	Yes	Yes	Fillable Fileable Signable
Other-Dynamic Pathing Internet Screens (Sample)	Upload Documents Dynamic Forms Screen Package - Sample (SSA 4162).pdf	www.ssa.gov (mySocial Security Account)	Yes	Yes	Fillable Fileable Signable
Other-Revised Privacy Act Statement	Upload Documents - Revised Privacy Act Statement.pdf	www.ssa.gov	Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 115,369	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	115,369	-789,200	904,569
Annual IC Time Burden (Hours)	365,335	-102,026	467,361
Annual IC Cost Burden (Dollars)	0	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.