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HA-4633 - Electronic Records Express Submissions
Claimant's Work Background
OMB: 0960-0300
IC ID: 243285
OMB.report
SSA
OMB 0960-0300
ICR 202508-0960-003
IC 243285
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
HA-4633 - Electronic Records Express Submissions
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 404.1520(a)(4)
20 CFR 404.1512(a)
20 CFR 416.965(b)
20 CFR 404.1565(b)
20 CFR 416.912(a)
20 CFR 416.920(a)(4)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
HA-4633
Claimant’s Work Background
HA-4633 - Revised Version.pdf
www.ssa.gov (mySocial Security Account - Representative Payees)
Yes
Yes
Fillable Fileable Signable
Other-Internet Screens
ERE Screen Package.pdf
www.ssa.gov (ERE)
Yes
Yes
Fillable Fileable Signable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
236,550
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
100 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
236,550
0
0
78,850
0
157,700
Annual IC Time Burden (Hours)
78,850
0
0
0
0
78,850
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Current HA-4633
HA-4633 (Prior to PRW Rule).pdf
03/11/2026
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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