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⚠️ Notice: This information collection may be referencing outdated material.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 - iSNO Screen Shots.pdf Other-Intranet (internal SSA) screen
iAccomodate screens.pdf Other-Intranet Screens
mySSA mySNO Screens.pdf Other-Intranet Screens
SSA-9000-F6 Request for Accommodation SSA-9000-F6.pdf Form

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 - iSNO Screen Shots.pdf	Yes	Yes	Fillable Fileable Signable
Form	SSA-9000-F6	Request for Accommodation	SSA-9000-F6.pdf	No		Paper Only
Other-Intranet Screens			iAccomodate screens.pdf	Yes	Yes	Fillable Fileable Signable
Other-Intranet Screens			mySSA mySNO Screens.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	Previously Approved
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	1,667	1,667
Annual IC Cost Burden (Dollars)	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.