Information Collection

COVID Screener Questions and Appointment Check-In - Mobile Application

IC 250429 under ICR 202202-0960-001 · OMB 0960-0066.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0066 can be found here:

Documents and Forms

Document Name Document Type
VIP Mobile OMB screen package.pdf Other-Mobile Application Screens
VIP Mobile OMB screen package.pdf Other-Mobile Application Screens

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	COVID Screener Questions and Appointment Check-In - Mobile Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 422.103 - 422.110

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Mobile Application Screens			VIP Mobile OMB screen package.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: 16,554	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	16,554	0	16,554
Annual IC Time Burden (Hours)	16,278	6,621	9,657
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.