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Federal forms, ICRs, and supporting documents

Information Collection

COVID Screener Questions and Appointment Check-In - Mobile Application

IC 250429 under ICR 202203-0960-013 · OMB 0960-0066.

Documents and Forms
Document Name
Document Type
Other-Mobile Application Screens
Other-Mobile Application Screens
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

COVID Screener Questions and Appointment Check-In - Mobile Application
 
No Modified
 
Mandatory
 
20 CFR 422.103 - 422.110

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Mobile Application Screens VIPr Mobile Check-in Screen Package - Revised.pdf Yes Yes Fillable Fileable Signable

Income Security General Retirement and Disability

 

16,554 0
   
Individuals or Households
 
   100 %

  Approved 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 16,554 0 0 0 0 16,554
Annual IC Time Burden (Hours) 16,278 0 0 0 0 16,278
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
VIPr Mobile Check-in Screen Package - Current VIPr Mobile Check-in Screen Package - Current.pdf 03/25/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.