SSA-827 (with electronic signature(eAuthorization)

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⚠️ Notice: This information collection may be referencing outdated material.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
Medical Release Form 827 EDCS Screens - eAuthorization.pdf Other-Internal Screens
eauthorization Final i3368 screens 022012 Finals.pdf www.socialsecurity.com Other-Internet Screens
Medical Release Form 827 Pages - Internet Appeals.pdf www.socialsecurity.com Other-Internet Screens
eAuthorization final eView screenshots.pdf Other-Internal Screens

Information Collection (IC) Details

IC Title:	SSA-827 (with electronic signature(eAuthorization)	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 404.1512 20 CFR 416.912 45 CFR 160 & 164

Information Collection Instruments:

Document Type	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internal Screens	Medical Release Form 827 EDCS Screens - eAuthorization.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	Medical Release Form 827 Pages - Internet Appeals.pdf	www.socialsecurity.com	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: 1,922,938	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	1,922,938	-787,177	2,710,115
Annual IC Time Burden (Hours)	288,441	-118,076	406,517
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.