Request for Accommodation in Communication Method

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0777 can be found here:

Documents and Forms

Document Name Document Type
SSA-9000 - Screen Shots - Revised Version.pdf Other-Intranet (internal SSA) screen
iAccommodate Intranet Screens - Revised Version.pdf Other-Intranet Screens
SSA-9000-F6 Request for Accommodation SSA-9000-F6 - Revised Version.pdf Form
SSA-9000 - Screen Shots - Current Version.pdf Current SSA-9000 Intranet Screen Shots IC Document
SSA-9000-F6 - Current Version.pdf Current Paper SSA-9000-F6 IC Document
iAccommodate Intranet Screens - Current Version.pdf Current iAccommodate Screens IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Request for Accommodation in Communication Method	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 85.51

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Intranet (internal SSA) screens			SSA-9000 - Screen Shots - Revised Version.pdf	Yes	Yes	Fillable Fileable Signable
Form	SSA-9000-F6	Request for Accommodation	SSA-9000-F6 - Revised Version.pdf	No		Paper Only
Other-Intranet Screens			iAccommodate Intranet Screens - Revised Version.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: 5,000	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	5,000	3,583	1,417
Annual IC Time Burden (Hours)	1,667	1,195	472
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSA-9000 Intranet Screen Shots	SSA-9000 - Screen Shots - Current Version.pdf	10/31/2016
Current Paper SSA-9000-F6	SSA-9000-F6 - Current Version.pdf	10/31/2016
Current iAccommodate Screens	iAccommodate Intranet Screens - Current Version.pdf	10/31/2016

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