SSA-827 (with electronic signature(adult first person only)

Authorization to Disclose Information to the Social Security Administration

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0623 can be found here:

Documents and Forms

Document Name Document Type
eAuthorization final EDCS screenshots for OMB).pdf Other-Internal Screens
eauthorization Final i3368 screens 022012 Finals.pdf www.socialsecurity.com Other-Internet Screens
eAuthorization final i3341 screens 022012 Finals.pdf www.socialsecurity.com Other-Internet Screens
PA Statement for SSA-827.pdf Other-Internal Screens
eAuthorization final eView screenshots.pdf Other-Internal Screens
eAuthorization Screens for July 2013 release - childhood claims.pdf Other-Internal Screens

Information Collection (IC) Details

IC Title:	SSA-827 (with electronic signature(adult first person only)	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 416.912 20 CFR 404.1512 45 CFR 160 & 164

Information Collection Instruments:

Document Type	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internal Screens	eAuthorization Screens for July 2013 release - childhood claims.pdf		Yes	Yes	Fillable Fileable Signable
Other-Internal Screens	eAuthorization final EDCS screenshots for OMB).pdf		Yes	Yes	Fillable Fileable Signable
Other-Internet Screens	eauthorization Final i3368 screens 022012 Finals.pdf	www.socialsecurity.com	Yes	Yes	Fillable Fileable Signable
Other-Internet Screens	eAuthorization final i3341 screens 022012 Finals.pdf	www.socialsecurity.com	Yes	Yes	Fillable Fileable Signable
Other-Internal Screens	PA Statement for SSA-827.pdf		Yes	Yes	Fillable Fileable Signable
Other-Internal Screens	eAuthorization final eView screenshots.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: 2,710,115	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,710,115	180,115	2,530,000
Annual IC Time Burden (Hours)	406,517	27,017	379,500
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.